Glabellar Scar Revision

Q: Dr. Eppley, I need scar revision surgery. I have already had one procedure on my forehead to improve the look of the scar, but  following the revision surgery (which was over two years ago) scar tissue slowly developed creating a deep crevice in the middle of my forehead. The crease is perfectly straight, which is very noticeable. My kids refer to it as the “butt crack” on my face. Attached are some photos.

My biggest concern is the “butt crack.” I am not sure if you can revise the scar to minimize the crease. I would actually prefer to have someone create a new incision where the crease is, remove some of the underlying bulging scar tissue, and then sew it up in a zig-zag pattern so that it is not so straight and noticeable and to prevent it from getting deeper in the future. IT would not bother me at all if some scar tissue developed under the “butt crack” to keep it from becoming a deep crease on my face again.

A: Thank you for sending your pictures. That is the type of glabellar forehead scar I have treated numerous times before. The reality is it is deceptively more difficult to make improvement than it seems because of its depth and the muscle contraction that runs perpendicular to it. Simple scar revision will not work as your own experience indicates. While a geometric excision and closure is needed for the skin, it is what is done underneath that will make the real difference in improvement. Volume needs to be added as well as muscle rearrangement. I usually do this by augmenting the bone with an ePTFE implant and excising and rearranging the muscle before the skin part of the scar revision procedure.

Dr. Barry Eppley

Indianapolis, Indiana