Q: Dr. Eppley, I have linear scleroderma which affects my forehead and would be interested in discussing how it could be treated. I’m 44 and balding, so the scar is much more prevalent than it had been when I had more hair. According my doctor out here, it’s burned out. I’d like to learn more about your experience with this problem and how you might look to correct it.
A: Your linear scleroderma involvement of the forehead and scalp is fairly classic, going down (or up) along the pathway of the 1st division of the trigeminal nerve. At your age it would be fairly common that the disease process has burned itself out. There are numerous approaches to the reconstruction of the aesthetic forehead defects from it, most of which focus on volume restoration using various forms of fat grafting. The problem with that exclusive approach is that it can not restore the quality of the overlying skin which is usually thinner and discolored to some degree. Even with volume enhancement, the vertical orientation of the involved skin is still very apparent.
In your linear scleroderma case, I would use two different surgical techniques which are different. On the forehead, I would excise the entire length of the involved skin and put the closure back together in a broken line closure methods due to the numerous horizontal wrinkle lines that you have. This would be an ideal way to really hide the scar well. This would not only ensure a permanent and assured resolution to the forehead soft tissue defect but also gets rid of the deformed skin. On the scalp, however, a different approach would be used as it is smooth skin with no wrinkles lines to help hide the scar. I would do fat injection grafting to restore the indentation only.
Dr. Barry Eppley