Q: Dr. Eppley, I was in a bad car accident over 15 years ago. I had a tracheostomy to enable me to breathe. But it has left a terrible scar. Growing up through high school, college, and even some times today; people tease me about having a “hickey.” Also even children who I do not even know will point to me to their mothers after they see me because they notice the scar on my neck. I am tired of being teased by people I know and even young children who do not even know me at all. Would I be able to have tracheostomy scar revision to remove the scar. (The doctor “fashioned” the scar to look like a cross but since it’s over 10 years old, the scar does not resemble a scar.
A: I think there is no doubt that your tracheostomy scar had a lot of room for improvement. I would not use the term tracheostomy scar ‘removal’ as that would be impossible to never have any scar on your neck. But minimizing it is the realistic goal so the proper term would be tracheostomy scar revision or tracheostomy scar reduction. This would require complete horizontal scar excision, surrounding skin underming, possible dermal-graft placed underneath and then a linear layered closure done. While initially his would be just a fine line scar, it would take a few months to see if any scar widening developed. (although never to the degree that you have now) One should even think about a second stage revision or laser resurfacing for optimal improvement should the scar become a little wide although I would hope this would be unnecessary. This is a procedure that could be done general or IV sedation an an outpatient procedure. There essentially is no recovery from it other than scar healing.
Dr. Barry Eppley
Q: Dr. Eppley, I have heard alot about you and even read alot about the scar revisions you do on the internet. I found your website very helpful. I had a car accident in January, 2010. I had an injury under my chin. I was taken to the hospital and the doctor just cleaned the wound and put a band-aid on it. After a month when i shaved i had two scars under my chin. one in oval shape and one in small line red-pinkish in color. I showed it to a plastic surgeon and he told me to use Kelo-cote gel for two months. i used it for 2 months and the scar was a little bit soft but not much result was seen. Then n November, 2010 i had a revision surgery on both the scars. One remained the same and the other was reduced to 60% of the original since doctor had told me she will reduce the whole scar in two surgeries. I am not satisfied with the results from the first surgery. The scar is very visible and is pinkish in color and is even more visible now. I am attaching a picture of my scar before surgery and after revision. I would welcome your recommendations.
A: In looking at your submental or neck scars, I can see that both scars are fairly wide and in need of further scar revision. The biggest scar from the beginning was a tough assigment given its very large width. I have no idea as to the type of scar revision that was performed but I suspect it was a simple linear excision. Both scars would fare better with geometric approach to scar revision to distribute the tension on the closure better to decrease the amount of postoperatve widening. This is particularly needed when the excisions are wide and in an area prone to scar stretching influences.
Dr. Barry Eppley