What Is The Best Approach For A Scalp Scar Revision?
Q: Dr. Eppley, I am reaching out to you in regards to my son who is an early teen. He had a nevus sebaceous birthmark removed from the crown of his headless year. The plastic surgeon was able to do a primary closure. At first the scar looked great, but at almost a month , the scar widened dramatically. Now we have him scheduled for a scar revision with a different plastic surgeon who wants to do extensive undermining and galeal scoring with vertical mattress suturing. Can you give me some insight?
A: It is perfectly normal and to be expected that all scalp scars will widen with any form of excision. The size of the excision will determine how much subsequent widening will occur. This is an unavoidable phenomena because the scalp is tight and is really skin stretched over a beach ball so to speak. While the scar may look great for a few weeks, the widening will subsequently occur. The extent of the widening will be fully manifest by three months after surgery and no revision should ever be done before them…as the tissues need time to relax. This is all part of the typical preoperative education.
I tell all scalp excisional patients, particularly children and teens, that there will be a likely 100% chance of the need for subsequent scar revision. Most likely the wide scar is less than the original excision so the tension will be less and the scar will be better. The techniques that have been described are appropriate and represent the maximum approach for ‘Plan B’.
There is also the phenomenon of lost hair next to scar which can be confused with a ‘wide scar.’ The scar is actually narrow but loss of hair (hair shedding) makes it look wider than it is. In some scars it may be a combination of a true wide scar and loss of hair shafts. This is another reason to wait to see what impact any hair regrowth will create on the scar’s appearance.
Dr. Barry Eppley