Is scar revision and Botox for facial scars effective?

Question

Hi doctor,

I was bitten by a dog three months ago and developed multiple scars, the worst one above my upper lip. At 55 days post-bite, a dermatologist performed a YAG laser session for redness. I was worried it was too early, but he reassured me it was safe. The procedure was very painful and caused blisters the next day, which healed after two weeks.

One and a half years later, my scar, which was initially a thin red line, now looks worse with indentations and tissue loss. The dermatologist first said it would resolve, but later told me it may take up to two years. This has left me devastated and very depressed, as the scar is affecting me psychologically.

I have been using Cica Care (silicone sheets), but have not seen improvement. The doctor suggested Hydroquinone, but I no longer trust his advice. I am scared because the scar looks wider now.

My main concerns are:

Can the sunken areas improve with time and flatten back to a line?
If there is no improvement, can scar revision make it less visible without lengthening the scar?
What revision techniques are best suited for this site? Would multiple procedures be required?
Do I still have hope for good results?

Please guide me.

Thank you

Answer 1

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's identity). The first scar was definitely a small linear one, which could have been corrected by fewer 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 this. The post-laser picture shows that it has 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 made a better decision.

Right now, the scar is having two main problems that is, the depression and the pigmentation, which are 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.

As suggested, the Hydroquinone with an Isotretinoin-based cream will help in depigmenting it. Both these methods have to be 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 a personal examination of the scar.

I hope this helps you.

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

The scar revision surgery is for the scar. I would not have preferred it, as it is on the face, and the second thing is that the scars are in a line against the tension lines. That will cause tension in the revision suturing. However, suppose you are going for the revision. In that case, you can opt for Botox injections post-suturing that will paralyze the underlying muscles for two to three months and will help heal the suture line better. The micro-needling with platelet-rich plasma (PRP) is a choice with which we have good results.

At least, that is what is commonly followed, and I would have preferred that over the revision and Botox. Please discuss all these options with a certified plastic surgeon with whom you are thinking of getting the surgery. You will get good results, do not worry.

I hope this helps you.

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

First of all, the derma pen is a good option for micro-needling. You can go ahead with the procedure, and then this is a good time you to begin with the procedure. I can see that the scar has platelet-rich plasma (PRP). If it is already five monthsready settled down, and there is no more erythema. The pigmentation and depression, however, are a concern. Sorry to say, but I am truly not aware of the therapeutic effects of castor oil in cases of a depressed scar. The eyelids are not visible properly in any of the pics you have sent (attachment removed to protect the patient's identity).

However, if it is the lower eyelid depression you 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. As far as the nose is concerned, I can see mild asymmetry and a bulge of the tip. A physical examination will help determine the bone and cartilage status and, hence, the next step in correction. Lastly, if you are genuinely considering the scar revision, then for the size of scar you are having, a single sitting will be enough, along with Botox, as I said. If the body reacts well, then no other interventions might be required.

I hope the answers are helpful.

Thank you.

Answer 4

Hello,

Welcome back to icliniq.com.

The scar revision might extend the scar by one-third, but that will be a more linear scar. A scar revision will be safer than the Co2 laser, as you already got the burns due to lasers. Subcision with platelet-rich plasma or nano fat grafting is an alternative choice to the derma pen. If it is more of skin laxity, opt for blepharoplasty rather than a fat graft. For a disfigured nose and rhinoplasty, choose a plastic surgeon over an otolaryngologist.

Thank you.