How Can The Scar On My Forehead Be Improved?
Q: Dr. Eppley, I am a 22 year-old girl who has a dented scar in the middle of my forehead as big as a dime. It is circular so filler will not work. Can tissue expansion work to create a new forehead? Is it possible to combine it with forehead lowering surgery. I figured that the scar from the expansion will be in the scalp or new hairline. I can send you pictures of my scar if you’d like. I really need a doctor to help me as I am constantly hiding behind hair and hats.
A: A round scar in the forehead poses a challenge unless it is very small and can be elliptically excised with a very small scar. But a round scar the size of a dime just about anywhere on the forehead is not an easy problem to improve, particularly if it right in the middle of the forehead. While it can elliptically excised, the length of the scar in the middle of a young woman’s forehead would not be a good trade-off and may actually even be worse. It is true that the forehead skin could be expanded and then the scar excised but that is a lot of effort to still end up with a visible scar even if its length is a little smaller and not ending up quite as wide. I don’t view tissue expansion as a viable option either.
I would recommend one of two potential approaches. The first is staged serial excision. This is in effect a ‘poor man’s’ tissue expansion. Do an initial scar excision that stays inside the boundaries of the round scar. Let it heal for 6 months and then come back and do it again. It may even require a third time excision but the goal is to eventually have a linear scar that is not much bigger than the diameter of the initial scar and be a fine line that is not indented. The other option is to try and fill it with either a fat injection or a dermal-fat graft. In essence, try to improve the contour but do not make any more scar that what you already have. Whether either of these is reasonable would depend on what the scar looks like. For this reason seeing a picture of it would be very helpful.
There is also the possibility that no method is really worthwhile for this depressed circular forehead scar and it may be left alone.
Dr. Barry Eppley