What Type Of Lip Scar Revision Do I Need?
Q: Dr. Eppley, I’m looking for some lip scar revision. Years ago I had Goretex strips implanted. Doctors finally took the implants out but tubular scar tissue remains that has not gone away even after shots of Kenalog for at least a year. I’ve also used mouth stretchers and massaged which has helped somewhat. However the major problem is that my top lip curls under when I smile which makes me very self conscious. After online research I think the issue is the scar tissue has gotten connected to the vermillion muscle as my scar tissue raises above my actual lip into the white area when I smile, otherwise it looks normal. I hear the only thing you can do is detach the scar tissue from vermillion with a needle subcision and hope it doesn’t grow back together. I wanted to get your thoughts on this procedure, and the likelihood that the scar and muscle will grow back together and whether post op fillers in between would help keep it separated?
A: You are correct in the diagnosis of a linear scar contracture from the path of the previous implants. Since it is impractical to completely excise the scar, scar release (subcision) would be the next logical approach. However, I do not believe that a type of lip scar revision that just includes a scar release alone will suffice as any gaps created in the scar line would just fill back in with more scar tissue. Rather than using injectable fillers after the procedure, I would recommend injecting fat at the subcision sites at the time they are released. You need a tissue graft that has the capability to form live tissue if the scar releases are too work.
Dr. Barry Eppley