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Q. Will scar revision work give me a virtually invisible scar?

Answered by
Dr. Pavan N Murdeshwar
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 24, 2018

Hi doctor,

I have been bitten by a dog three months ago. I have multiple scars but the worst one is above the upper lip. Unfortunately, I went to a dermatologist recommended by family and he insisted to apply Yag Laser at 55 days post-bite. I asked if it was not too soon but he said it was harmless and would only be targeting the vessels that were giving the scar the red color. I trusted and it hurt a lot. Immediately after it was horrible looking but the doctor said it was normal and not to worry. The next day I had blisters that resolved two weeks later. One month and a half later my scar that was a red line is now horrible and has local indentations. Seems that I have lost tissue on the blisters site. 15 days ago the dermatologist said it would resolve and I would not be worst than before the laser. Now I returned to his office and he tells me that it may pass but it will take two years. I am devastated and so depressed. It has been psychological hell.

Can the sunken areas really fill with time and become a line scar again? I am more than a month and a half now. I have red people burned by YAG laser and never recovered. I have been applying Cica Care (silicone sheet) but I do not see any improvement. The doctor wants me to apply Hydroquinone but I stopped to trust him really. Also in a few months, if the skin does not return to normal level, will scar revision work on this site to give me a virtually invisible scar? I am so scared because the burn area with the scar is now wide. Can the revision be made without lengthening the scar? Do I have hope? What techniques of revision should be approached? Would it require multiple stages? Please help me.

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#

Hello,

Welcome to icliniq.com.

First of all, sorry for the unfortunate events you are going through. I have seen your pictures (attachment removed to protect patient identity). The first scar was definitely a small linear one which could have been corrected by few non-interventional methods than the lasers as you said it was just 55 days old. However, the YAG laser is known for its potential to decrease the increased vascularity in such scars and help improve the outcome. So I do not think your dermatologist is wrong in suggesting you this.

The post-laser picture shows that it second-degree burns, which is a common side effect of YAG, which had to be explained to you by your dermatologist beforehand, and you could have taken a better decision. Right now the scar is having two main problems, that is the depression and the pigmentation which is making it look worse.

My suggestion would be to ask for micro-needling with PRP (platelet-rich plasma) or fat nano grafting underneath the scar will give you the elevation in the scar. And as suggested, the Hydroquinone with an Isotretinoin based cream will help in depigmenting it. Both these methods has to done in a proper protocol. Do discuss these things with your dermatologist, or a new skin specialist and let him or her come to the best decision after personal examination of the scar.

For more information consult a plastic surgeon online --> https://www.icliniq.com/ask-a-doctor-online/plastic-surgeon

Thank your for your answer. I've been searching about microneedling and scars with or without prp and i don't see any photo showing a significant improving. Also many who have done it alerts for aditional scarring? Is this true?
What about scar revision surgery? Unfortunately the way it is it seems that it's the only definitive way to handle a big scar that is now. Do you think in this place of face with surgery i can achieve a thin line that with time can become virtually invisible?
# Hello Daniel.... The scar revision surgery in that scar! I wouldn't have preferred, as it's on the face, and second thing the scars are in a line against the tension lines what we say in that region. That will cause tension on the revision Suturing.... However if u are going for the revision, u can opt for botox injections post Suturing, that will paralyze the underlying muscles for a period of 2-3 months and help in healing if the suture line better.
The microneedling with prp is an alternative choice with which we have hot good results.. Atleast thats what is followed at our center and I'd have preferred that over the revision and botox.
Please do discuss all these options with the certified plastic surgeon with whom u are thinking of getting the surgery with. U will get good results, don't worry.
Hi Dr. Pavan. I'm planning to see a plastic surgeon in a month. He lists on his site that he performs "Dermapen". When you recommend me microneedling with PRP, it could be with Dermapen?

When do you think it is recommend for me to start it? Should i wait more time expecting the scar to heal/fill up? I'm with 5 months post bite and 3 months post burn laser on scars. I have no follicles in the burn area. Does it mean dermapen won't be effective or can cause aditional scarring? i've red that follicles are needed for healing. The last photos doesnt show much indentation but it still there, very indented and seeming like holes in harsh lighting.

There's this site when someone used castor oil for 9 months and healed a two year old scar, a indented one that got filled up. More two people commented the same regime and filling over time indented burn scars. Do you think i can try applying castor oil in expecting some healing and filling up?
https://skinverse.com/how-castor-oil-healed-my-scar-with-before-and-after-photos/

My face seems very different from previously the attack of the dog. The dog bite me all around my nose. One inferior EYELID seems always deeper than the other and like i've been punched not long ago - (i was bitten there too...do you think i have lost some sort of fat there or i got extra skin on the eyelid?). I feel very assymetric. Can it be corrected?

I went to see 2 otolaryngologist because of my nose. An x-ray 3 weeks later injury revealed no fracture but a CT one month later revelead comminuted fracture on one side. After 5 months of injury where i'm now, my nose seems very different, my tip is AT LEAST TWICE THE ORIGINAL SIZE and it seems very assymetric as the photo shows. The first otolaryngologist said there was nothing wrong my nose (that the fracture was not perceptible). The second said that i have depression on one side making the nose seem assymetrical. What is most strange is that when i bend my face lateral or i lie down on the left, the tip seems TO SHIFT TO ONE SIDE. Also my face gets visually distorted on side position, even if i bend my head to one side or other – seems like muscles dont follow. But if i smile, if i raise my eyebrows, its simetrical. Can a hidden paralysis justify this change in face shape as i lay or bend head on side? Will my tip volume ever be normal again? The second doctor said it was risky trying to correct my nose… but being used to have a tiny nose makes me look not me anymore.

So you see i'm a mess :(. Scars, changed nose, changed eyelid.. . changed face

These are many questions, sorry. Just last one, if i opted months from here for a scar revision could a MULTIPLE STAGE (serial excision) one be effective? On realself, this man had a severe scar in face and ended with no trace at all.
https://www.realself.com/review/dallas-dr-pero-basically-worked-miracle?offset=7&sle=0#

I'm sending you 4 photos:
- one showing the scars without light
- other showing the scars in light revealing easily the indentation
- other showing my nose: the bridge thin and the tip very large
- two showing my nose before the bite


Thank you
# Hello Daniel.... Long time hearing from you.... And I can understand how much stress you are in regarding the scar. Thanks for attaching the appropriate pics.
1) first of all, ya the derma pen is a good option for microneedling... U can go ahead with the procedure along with the prp...
2) if it's already 5 months, then this is a good time for u to begin with the procedure. I can see that the scar has already settled down and there's no more of erythema... The pigmentation and depression however is a concern.
3) sorry to say but I'm truly not aware of the therapeutic effects of castor oil in cases of a depressed scar. The case u have sent, seems to be having just a post burn pigmentation, which do diminish with oil massages. But it's difficult to say the same in your case.
4) the eyelids aren't visible properly in any of the pics u have sent. (2 of the pics didn't open due to some formatting issues) however if it's the lower Eyelid depression u are worried about, then there are instances where the fat regression happens post trauma, resulting in such deformity. Getting it checked with a good plastic surgeon will help you.
5) as far as the nose is concerned, I can see mild asymmetry and the bulbousness of the tip. A physical examination will help in knowing the bone/cartilage status and hence the next step in correction.
6) lastly, if u are truly considering the scar revision, then for the size of scar u are having, a single sitting will be enough,along with botox, as I said. And if the body is reacting good then no other interventions might be required.
Hope the answers are helpful. Wishing u all the best..
Thank you Dr. Pavan. you're always detailed in your answering.
1 - I'm taking your words since the start believe me. I hope scar revision will be the last option for me - too many risks. You say that only one sitting would be necessary, but that way considering the wideness of the scar would it be possible to mantain the lenght of the original? or would i end up with a longer scar?
2 - I'm really looking forward to dermapen. What are the REALISTIC expectations i can get with it, referring to scarring and indentations? Please tell me by YOUR EXPERIENCE. Can the indentation be reversed with Dermapen? i'm sharing some public photos where 3 we see some improvement and one none at all. Have i any risks? The second dermatologist i visited wanted to do Co2 laser - i'm totally out of it as i was burned by one laser and i never saw a photo of improvement in indentations with Co2 laser. I've red that microneed is way more safe. Do you think the same?
3 - What do you think of subcision or needling/suction for indentations?
4 - when i stretch my inferior eyelid it seems normal. Perhaps trauma induced skin laxity? What would you recommend in that case? Blepharoplasty or fat injection? Fat injection has very high risk and is not permanent right? I've seen photos of people disfigured in the eyes by it.
4 - Can i ask one more thing: based on your experience if i'll ltry to correct my nose who's more appropriate: the otolaryngo or the plastic surgeon? The 2 otolaryngo gave me discrepant opinions and seemed to not care about esthetics, only nasal function.

Thank you so much again, i know its really a lot of questions, but for your words i think you understand the kind of traumatic situation i'm in. your answers are always helpful.
# Hello Daniel...
1) the scar revision might extend the scar by 1/3rd, but that will be more linear scar.
2) a scar revision will be safer than the co2 laser, more as u already got the burns due u to lasers.
3) subcision with prp or Nano fat grafting is definitely an alternative choice to derma pen.
4) if it's more of skin laxity then opt for blepharoplasty rather than fat graft
5) for a disfigured nose and hence Rhinoplasty, chose a plastic surgeon over an otolaryngologist...
Thank you..

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