Q: Dr. Eppley, I would like to get a consult on a scar revision on my shoulder. I had a small keloid scar (about .5cm) on her left back shoulder that a dermatologist tried to remove with elliptical excision a couple years ago. Unfortunately the healing process was disrupted by a complication infection that was caused by the technician not properly removing the sutures. Remaining suture fragments were later found embedded and removed by an urgent care physician. The excision expanded and the result is a much larger keloid scar. (about 3x3cm) I’m attaching two photographs for you to get the idea of its current size. You can vaguely make out the shape of the excision scar which is surrounded by the individual suture scars.
I am interested in a consult to determine if there is a revision option that would at worst leave her with a much less prominent scar.
A: Thank you for sending pictures of your shoulder scar. This is a very tough area for scar revision to make improvements due to the thickness of the skin and the continual tension that is on the shoulder area. Without surgery, of course, there will be no improvement. With surgery there is a chance for improvement but it is certainly no guarantee.
Because of the skin tension issues in this body area, the most prudent approach is a serial scar excision. What this means is to do an initial subtotal excision (inner two-thirds), let it heal and see what it looks like in three months. If it remains less in size then go for the completion excision with confidence that it will end up much smaller than it is now….with no risk that it can become bigger. This would be the safest approach to lessening the risk of making the scar no better in the end with further surgery or even making it bigger.
Dr. Barry Eppley