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Healing after scar excision

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#1 amc107

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Posted 06 June 2011 - 12:05 PM

Hello all!

I had a pretty deep acne scar on my cheek, and it bothered me so much that I started to look into techniques for improving its appearance. After going through several of the message boards on this site and reading about others' experiences, I decided to make an appointment with my dermatologist in hopes of getting a scar excision performed.

My dermatologist agreed that this would be the best method for improving the appearance of the area, and she did a 3mm-wide punch excision. The procedure was very quick and painless!

Well, my dilemma comes now that I have had the stitches taken out. They were in for 7 days, but now that they're out, the area immediately around the excision still looks a little bit depressed compared to the rest of my skin. I can't tell if the area surrounding is a little bit swollen and that's why it looks deeper... I was a little concerned about this when I first had the stitches out, but the dermatologist told me that it looked perfect. She said that everyday it would become a little lighter and tighter, and the nurse told me that the area would kind of granulate in...

I was just wondering if this is typically how scar excisions heal... I have read that it usually looks worse before it looks better. It's only been a few days since the stitches were taken out, but I am a little worried that I am still going to have a slight depression rather than just a little red line.

Any insight on this would be appreciated!

#2 michael24

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Posted 06 June 2011 - 02:22 PM

Pictures???

#3 Minty Peas

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Posted 06 June 2011 - 02:45 PM

Sorry, I don't have any advice for how you should be healing. I just wanted to wish you the best of luck with your treatment. Also, if you're worried about something it's always okay to call your doctors office or send them an email. I'm sure they'll either reassure you or ask you come in so they can take a look at it.

#4 Nightlilly89

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Posted 06 June 2011 - 02:50 PM

QUOTE (amc107 @ Jun 6 2011, 02:05 PM) <{POST_SNAPBACK}>
Hello all!

I had a pretty deep acne scar on my cheek, and it bothered me so much that I started to look into techniques for improving its appearance. After going through several of the message boards on this site and reading about others' experiences, I decided to make an appointment with my dermatologist in hopes of getting a scar excision performed.

My dermatologist agreed that this would be the best method for improving the appearance of the area, and she did a 3mm-wide punch excision. The procedure was very quick and painless!

Well, my dilemma comes now that I have had the stitches taken out. They were in for 7 days, but now that they're out, the area immediately around the excision still looks a little bit depressed compared to the rest of my skin. I can't tell if the area surrounding is a little bit swollen and that's why it looks deeper... I was a little concerned about this when I first had the stitches out, but the dermatologist told me that it looked perfect. She said that everyday it would become a little lighter and tighter, and the nurse told me that the area would kind of granulate in...

I was just wondering if this is typically how scar excisions heal... I have read that it usually looks worse before it looks better. It's only been a few days since the stitches were taken out, but I am a little worried that I am still going to have a slight depression rather than just a little red line.

Any insight on this would be appreciated!


Make sure you keep tension off the excision line. Especially for the first two weeks and when you sleep at night. If you want I can PM you some info that a person on this site recommended me a while ago. He had some pretty good ideas and tips to heal as best as possible. If there is tension on the incision line though, the scar worst case scenario will reopen and look worse than what you started with. Steri strip it, do what you can .


#5 Guest_Timehealsall_*

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Posted 06 June 2011 - 08:08 PM

perform a search on miramira thread

#6 miramar

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Posted 06 June 2011 - 08:16 PM

This is what happens week by week after your stitches come out. First of all, you should've gone to a plastic surgeon and went with scalpel excision, it would've been the better guarantee of success. Not that punch excision doesn't work, but punch excisions are not as exact and dermatologists aren't really surgeons. But having said that, here's what to expect week by week after your remove your stitches.

Week one: All you see is a thin incision line, the area around it should not be red nor depressed.

Week two: The area becomes very red, and the skin area above/below the incision line becomes swollen as the body starts to load gather up proteins and collagen to fix the wound. This is the phase where the wound swells, gets red and expands. Week two is usually the week most people refer to as "it gets worst" before it gets better. The redness and swelling will make it look like it is depressed, but rest assured, overtime the redness will fade (about a month to 3 months) and overtime the swelling will go flat (also about a month to 3 months)

Week three: Swelling begins to go down, redness begins to fade, the incision line starts to blend

Week four: It should be about pinkish, flat and the incision line should have disappeared by now completely.

If it hasn't, the remodeling continues for a year, but generally most everything is finished by 1-3 months. So whatever you see after that will only show modest improvement. I'd say after 3 months is the time to seek revision if it hasn't healed properly by then. Keep in mind that you can revise the scar as many times as you wish until it is perfect, but next time, please skip the derm and the cookie cutter tool. Cookie cutter tools, the punch tools were originally designed to take a chunk of skin out for biopsies of cancers or what not, they are too crude for excisions. Scalpel will yield better results, and plastic surgeons will have better techniques and understanding of scar revisions than derms. Oh please by some strong tape, and tape the area for at least 2 weeks to a month to prevent tension. And be careful when you untape it too, because pulling tape off the wound creates it own tension if it is the really sticky kind. Remember that the surgery is only half the work, the other half is how you take care of the wound. Just keep it moist and tension free and the body will do the rest. When you wash it, just "lightly" apply soap over area and let the water flush soap off, that's how tender you have to treat it until it gains sufficient stength, you have to baby that wound like you can't touch it if you don't have to, no facial expressions if you can, just really think about the things you do and the tensions that it creates, to give yourself the best chances of success. If you fail, think about what you or the derm did wrong, and re-excise it, but this time, please oh please, go scalpel and go plastic surgeon. NO DERMS! and NO PUNCH TOOLS!

#7 Keep_The_Hope_Alive

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Posted 07 June 2011 - 05:51 AM

AMC 107,

I had a large facial excision performed on my cheek bone because it consisted of a large deep acne/I don't even know scar. I asked the plastic surgeon to remove it entirely. At first he was hesitant because I told him I wanted the entire area taken out on that side and would be fine with a straight linear scar. This is what he provided me and I'm super happy with it. After everything the only scar I will be left with on my face is a straight line no more then 3cm that looks like a war wound from a ninja battle : ) Anyways with regard to your concern of the level of the scar with the rest of your skin I initially was worried about the same thing. Your skin will adjust. It goes through a few stages of swelling etc. If after 6 months it's still indented then you will need another excision and the doctor you went to was not very good... I hope this helps in some way. Just keep massaging the scar daily with ointment. P.S. WEAR SUNSCREEN!

#8 amc107

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Posted 07 June 2011 - 08:38 AM

I had thought about going to a plastic surgeon instead of a derm, but she specializes in cosmetic surgery, so I didn't see the problem with it. She also told me that she does this procedure all the time. I trust that she knew what she was doing!

She put a steri strip over the incision after the stitches came out, and said it would be on for a few days. Once it fell off she said I didn't have to do anything; no ointments or strips, etc. The strip actually fell off after the first night I had it on, but I replaced it. These things don't seem to stick too well to my face, so I have to keep changing it. I will probably wear the strip for a while longer just in case.

It doesn't look to me like the wound has opened... I can still see the incision line and everything. I am hoping that the reason that it looks this way it just because it is swollen around it and is still healing, as some of you mentioned. It is pretty red around the area and the skin looks rough, and it is still itchy so I know it's doing something!

I started to get worried because other people had said once they got their stitches out, they were left with a perfectly flat line. I think the fact that this is on my cheek rather than a less fatty area may have something to do with it looking this way. Even if it doesn't work out the way I want the first time around, at least I know there are still things I can do to make it less noticeable!!


#9 miramar

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Posted 09 June 2011 - 04:44 PM

If you derm actually specializes in cosmetic "surgery" then it is all good, because normally derms are NOT trained in any type of surgery, that's why I always recommend plastic "surgeons" if you are going to do any surgery on a scar.

I was so disturbed reading a post about a guy who went to excise a chicken pox scar in the middle of his forehead, seeing a photo of why his excision failed. His "derm" excised his scar and oriented the incision line perpendicular to the natural wrinkle (tension) lines of the forehead, so that the incision line looked something like this ---------|---------- Think of the horizontal line as the natural wrinkles on your forehead...you know what created that horizontal line? Tension pulling from the sides. Now look at that poor little vertical line in the middle of that horizontal (i.e. tension) line, pulling right at the "middle" of the vertical (incision line)... my god, what chance does that poor little incision line have to counteract the incredible tension pulling force of the wrinkle line??? None, it was bound to fail. Now, if he went to a plastic surgeon. They would've made the incision line like this ---------- ---- -----------. You see the difference? There is a big difference just from this simple technique alone. Now when the tension line pulls on the incision line in the middle, there is no tension on the incision line. If anything, it is helping to close the incision more when there is tension on it just by making the incision line horizontal following the natural wrinkle lines instead of against it in the first example. Not only does this remove all tension on the incision line, but if any lines form after healing, the wrinkle lines will hide it and make it invisible. One should never go to a derm for surgeries if you want to succeed. Derms are good only for writing prescriptions. Surgeries are meant for plastic surgeons.

#10 amc107

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Posted 09 June 2011 - 06:20 PM

I don't see what the difference is between getting a mole removed and getting a scar removed, and I would go to a derm for that. Anyways, she positioned the angle of the incision line perfectly parallel to my smile line, and she noted that as she was doing it. Whether or not I should have gone to a plastic surgeon is besides the point now, because I am happy to note that the area is looking MUCH better and is nearly flat now. I have done nothing but keep it covered with a steri strip, no ointments or other treatments or anything. I am so far pretty happy with the results and can't wait to see what it looks like when it is fully healed! I do appreciate all of the advice though!


#11 miramar

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Posted 09 June 2011 - 10:35 PM

QUOTE (amc107 @ Jun 9 2011, 07:20 PM) <{POST_SNAPBACK}>
I don't see what the difference is between getting a mole removed and getting a scar removed, and I would go to a derm for that. Anyways, she positioned the angle of the incision line perfectly parallel to my smile line, and she noted that as she was doing it. Whether or not I should have gone to a plastic surgeon is besides the point now, because I am happy to note that the area is looking MUCH better and is nearly flat now. I have done nothing but keep it covered with a steri strip, no ointments or other treatments or anything. I am so far pretty happy with the results and can't wait to see what it looks like when it is fully healed! I do appreciate all of the advice though!


Notice, I said if your derm was a cosmetic "surgeon" then it was all good??? They have similar training as with plastic surgeons. It's great to hear everything is going alright. I think you've passed the vasodilation phase, and have entered the contraction, remodeling phases. Basically, it only gets better from here on out. It'll get flatter, tighter, and yes, the incision line will fade away completely if done right, so that, you'll have 100% scarfree resolution. Keep us posted on your progress, good luck!

Edited by miramar, 09 June 2011 - 11:00 PM.


#12 Neu2011

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Posted 08 July 2012 - 05:04 AM

This is what happens week by week after your stitches come out. First of all, you should've gone to a plastic surgeon and went with scalpel excision, it would've been the better guarantee of success. Not that punch excision doesn't work, but punch excisions are not as exact and dermatologists aren't really surgeons. But having said that, here's what to expect week by week after your remove your stitches.

Week one: All you see is a thin incision line, the area around it should not be red nor depressed.

Week two: The area becomes very red, and the skin area above/below the incision line becomes swollen as the body starts to load gather up proteins and collagen to fix the wound. This is the phase where the wound swells, gets red and expands. Week two is usually the week most people refer to as "it gets worst" before it gets better. The redness and swelling will make it look like it is depressed, but rest assured, overtime the redness will fade (about a month to 3 months) and overtime the swelling will go flat (also about a month to 3 months)

Week three: Swelling begins to go down, redness begins to fade, the incision line starts to blend

Week four: It should be about pinkish, flat and the incision line should have disappeared by now completely.

If it hasn't, the remodeling continues for a year, but generally most everything is finished by 1-3 months. So whatever you see after that will only show modest improvement. I'd say after 3 months is the time to seek revision if it hasn't healed properly by then. Keep in mind that you can revise the scar as many times as you wish until it is perfect, but next time, please skip the derm and the cookie cutter tool. Cookie cutter tools, the punch tools were originally designed to take a chunk of skin out for biopsies of cancers or what not, they are too crude for excisions. Scalpel will yield better results, and plastic surgeons will have better techniques and understanding of scar revisions than derms. Oh please by some strong tape, and tape the area for at least 2 weeks to a month to prevent tension. And be careful when you untape it too, because pulling tape off the wound creates it own tension if it is the really sticky kind. Remember that the surgery is only half the work, the other half is how you take care of the wound. Just keep it moist and tension free and the body will do the rest. When you wash it, just "lightly" apply soap over area and let the water flush soap off, that's how tender you have to treat it until it gains sufficient stength, you have to baby that wound like you can't touch it if you don't have to, no facial expressions if you can, just really think about the things you do and the tensions that it creates, to give yourself the best chances of success. If you fail, think about what you or the derm did wrong, and re-excise it, but this time, please oh please, go scalpel and go plastic surgeon. NO DERMS! and NO PUNCH TOOLS!


Hi miramar. I hope u will read this one and answering me some how.... anyway, I had my scalpel excision last week at Tue in Germany... went to a plastic surgeon near Munich. My stitches came out After 7 days and both scars was little open and bloody first... but the doctor told me everthing is fine, its just because removing them... then he put some steri-strips on both scars. He told me to change them if needed and start to use silicone cremes from the third week. So by changing the steri-strips after 10 days, I saw both scars finally closed as line scars, k? I was happy till yesterday when I gone for a shower and had to change them again. I noticed that they are really red but starting depressing... not just the lines, they more like circles and bigger area than the line and acne scars before!?!?!?! Some kinda in to outside depressing!?!? After searching the whole Internet, I finally found ur post and get a little more hope in the case of the second week as u said before? BTW: Both of the scars are in the middle of the left cheek... Thanks a LOT, Reza

Edited by Neu2011, 08 July 2012 - 05:29 AM.


#13 no_hope

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Posted 08 July 2012 - 03:18 PM

neu2011 would you be able to post a pic of the depressed circles your talkin about? im trying to picture it in my head but it is really hard. also i think LED's would be of great help when doing something like excision. it boost the healing greatly and maybe enhances the results. i too might do scalpel excision once i consult with a PS..
what kind of acars did you have excised?

#14 Neu2011

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Posted 09 July 2012 - 05:09 PM

hey no_hope. sure, will do... once i have to change the steri-strips in the next few days, k? my ps done some before but i didnt ask him for... LEDs? dunno but i would say boxcar to light rolling. today i consult my derm and she said they look good but need to be covered for 2-3 weeks more...

#15 no_hope

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Posted 09 July 2012 - 07:12 PM

hey no_hope. sure, will do... once i have to change the steri-strips in the next few days, k? my ps done some before but i didnt ask him for... LEDs? dunno but i would say boxcar to light rolling. today i consult my derm and she said they look good but need to be covered for 2-3 weeks more...

ic. besides the depression are you overall happy with the procedure? i know tension is supper imoportant when getting this done. it must be also chalenging i wish you the best of luck!

#16 Neu2011

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Posted 12 July 2012 - 10:00 AM


hey no_hope. sure, will do... once i have to change the steri-strips in the next few days, k? my ps done some before but i didnt ask him for... LEDs? dunno but i would say boxcar to light rolling. today i consult my derm and she said they look good but need to be covered for 2-3 weeks more...

ic. besides the depression are you overall happy with the procedure? i know tension is supper imoportant when getting this done. it must be also chalenging i wish you the best of luck!


hey there... yep & thats why i am going to do it again if the result doesnt match.... we all better worry about the ps :-) btw: pic ist posted in my gallery... you should see them both now... the big red one above ist about fraxel repair 2 months ago done by derm in munich... i hope this will fade soon... the healing there takes much more longer than others... thx and best, rs

#17 Neu2011

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Posted 21 July 2012 - 08:56 AM

k guys new pic added... to me its kinda looking worst than before?!?!?! btw: they are both still depressed... is this going to look better or worst by the time?!?!? wired?!?!?

#18 Neu2011

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Posted 26 July 2012 - 12:51 PM

k there... starting 4rd week post... pics added... and its finally going to look better... still a little depressed but getting definitely better i guess... lets see what tomorrow brings Posted Image)

Edited by Neu2011, 26 July 2012 - 12:56 PM.


#19 billybob2020

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Posted 22 March 2013 - 08:31 AM

Update on your exicision @ Neu2011? Any new procedures since your last post on here? Sorry I haven't searched the threads.