Holger G. Gassner, M.D., Board Certified Facial Plastic Surgeon (USA)


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SCAR REVISION & KELOIDE

Thickened and raised scarred skin are referred to as (hypertrophen) scars and are characterized separately from keloid.  Keloids are benign growths that often grow outwardly and extend beyond the original scar.
In the head and neck region, these often occur in the ears. The treatment of keloids is considered to be challenging, since they have a marked tendency to recur.

There are multiple techniques to improve the appearance of scars:

Scars maybe repositioned or changed in the direction by surgical techniques.  Scars that are visible because of their width maybe removed and replaced with a finer, less conspicuous scar.  Superficial treatments such as laser treatment or dermabrasion (mechanical polishing) may also be helpful.  Retracted scars may benefit from filler substances such as hyaluronic acid or fat transfer such as liposculputure.

The injection of small amounts of cortisone may help reduce inflammatory reactions.  This may have a positive effect on the healing of scars in the earlier periods of wound healing.  The negative effect of muscular activity on wound healing may also be a target for treatment.  Injection of botulinum toxin around a healing wound may improve the eventual cosmetic appearance of the scar.

The choice of the method as well as the timing requires very careful evaluation, experience and expertise.  Frequently multiple methods are confined at various points in time in order to achieve the best possible result.  In the early phases injections with cortisone and with botulinum toxin may be indicated.  In some instances a relatively early treatment with dermabrasion maybe useful after about 3 months after the injury.  Most techniques of scar revision however should not be utilized until the scar has matured for at least 1 year.

Scar treatments maybe performed at various points in time.  All in all typically the treatment lasts for many months or even longer and repeat visits with a physician will be required (continuity of treatment under the care of the same physician is recommended).  It is important that the surgeon learns about the characteristics and the changes within the scar through multiple follow-up visits.  Photographic documentation is also often useful.  There are important treatments in the very early phase of wound healing that include the injection of botulinum toxin and of asteroids.  Therefore it is advisable to see your surgeon early after a skin injury has taken place.

It is important to have a thorough discussion with your surgeon regarding the instructions to follow.

Dr. Gassner will give you detailed instructions on how to protect and treat the healing wound during the first consultation.  Typically the healing wound is protected from external stimuli for at least 3 months.  This includes the avoidance of bright sun, heat and cold such as direct sunlight and tanning beds (Solarium).

For at least 12 months, makeup or a sunscreen with a high SPF should be applied to the healing wound.

In certain areas of the face the activity of the underlying facial musculature influences the healing of wounds.  This is for example the case over the forehead, the cheek or around the mouth.  An injection of botulinum toxin in the early healing phase allows to weaken the muscles.  Thus the healing wound is immobilized and may heal with less mechanical distortion.

This may decrease inflammatory stimuli and thus allow for more favorable scaring to occur.  The injection of botulinum toxin should be performed early, at the very latest within 4 weeks after the initial injury.

If you have questions regarding the benefits and risks of such a procedure, or would like a consultation, please Contact us.

Gassner HG, Brissett AE, Otley CC, Boahene DK, Boggust AJ, Weaver AL, Sherris DA. Botulinum toxin to improve facial wound healing: A prospective, blinded, placebo-controlled study. Mayo Clin Proc. 2006 Aug;81(8):1023-8.

Gassner HG, Sherris DA. Chemoimmobilization: improving predictability in the treatment of facial scars. Plast Reconstr Surg. 2003 Oct;112(5):1464-6.

Sherris DA, Gassner HG. Botulinum toxin to minimize facial scarring. Facial Plast Surg. 2002 Feb;18(1):35-9.