Q: Dr. Eppley, I am planning on having a scar revision for a vertical scar on the bridge of my nose. At the same time I want to correct sinus problems: turbinoplasty, septoplasty as well as rhinoplasty for some minor aesthetic improvements. I’m hoping the minor nose humps can be grinded so they won’t exaggerate the contours of the scar. How can I minimize the new scar on the bridge from becoming widened over time, developing little arterioles, or the skin getting too thin? What laser should I plan for post-surgery?
A: Based on your question, I would need to have a better idea as to the type of external rhinoplasty you would be having. Will this involve rasping of the bridge or will it require osteotomies as well? Either way, however, I would not perform a scar revision directly over the nasal skin that is being raised during the rhinoplasty. This is not a blood supply concern but one of scar healing. The swelling of the nasal tissues after a rhinoplasty will work directly against having a good scar result. You would be much better to delay the scar revision to after the rhinoplasty, preferably 3 to 6 months later. Scar revision on raised rhinoplasty skin is not a good simultaneous idea if you want the best scar result.
Dr. Barry Eppley
Q: I have two surgical pitted crater-like scars on the side of my nose which are really annoying. I have previously tried erbium laser, two courses , nine months apart, and punch excision surgery, but neither treatment helped me. I noticed that your Doc had some impressive photographs of before and after scarring online and would like to know if I can be treated by way of any suggestion the Doc can make. I can send a photograph if you like.
A: The nose is one of the most difficult areas on the face for effective scar revision. The skin of the nose is tight, stretched over bone and cartilage and very thick. This leaves little skin laxity that can close easily after excisional scar revision and skin so thick that even deep laser resurfacing can not smooth out. In looking at your pictures, your two nasal scars are wide and very saucer-shaped. It is a wrong concept to try and bring the surrounding skin down to the level of the scar through any form of laser resurfacing. They are too deep. It is also not possible to excise them as they are too large and the nose has no skin laxity. What you what to think about is building up the scars from underneath with either cartilage or dermis/dermal grafts. They could be placed underneath the scars through an incision inside the nose. Building up the base of your nose scars is the only approach that will likely make them less noticeable by making their concave contour less so. Your nose scar revision is augmentative in nature.
Dr. Barry Eppley
Q: I got the mole on my nasal bridge removed by elliptical excesion. The wound got infected (pus). The stitches were removed after five days of operation. Because the pus was still there the wound opened up. Now 15 days after the removal of stitches, I am left with 1mm deep large hole in place of mole, which is still pink. Please suggest a remedy, My doctor says I should wait for three months, If the scar remaining is too big then I can go for another sugery. I dont want to wait for so long, as it is effecting my life . Please suggest something.
A: The strategy that your surgeon has suggested in this right one. It is better to let the wound heal and contract down in size. It is possible that it may heal to the point where you will find the scar acceptable. Most likely, however, this will not occur as the nose is one of the most unforgiving places to scar on the entire face. By letting it heal, the scar (like the original mole) can be excised again later. By this approach the size of the defect will be smaller and the tissue quality will be much better for handling and holding sutures. While this is certainly distressing to allow this process to evolve on a prominent area of your face, it is the wisest and will result in the best scar result long-term.