Hello guys and girls
I have been battling acne and acne scars for most of my life, but around 2011 I developed a particularly nasty scar which was the result of a cyst. I had scar revision performed in June 2015. The dermatologist used a non-dissolvable stitch. After the stitch was taken out the skin gradually came apart in the following weeks, leaving a red scar (figure 1). After this I had micro-needling done using an EDS Dermastamp in 2015. This did nothing to improve the appearance of my scar. In fact, it chewed it up and made it look worse. In January 2017 I bit the bullet again and had a second scar revision performed, this time with a non-dissolvable stitch and it was done by a cosmetic surgeon. Same story. Figure 2.jpg is a picture of my scar taken yesterday. My cosmetic surgeon has concluded that there is too much tension in this area for scar revision to be successful. There is simply not enough skin. I asked about tighter stitching patterns, but that would make the result worse as the tension would be even higher causing dehiscence again.
Moving forwards my surgeon has recommended a rotational flap procedure. Another surgeon said the same. I asked about a skin graft but he thinks it will look bad. I can't remember his exact words, but he thinks the stitching will create a pillow appearance.
I have tried other approaches. Vbeam doesn't work and there is esentially a shallow chunk of skin missing. I could have filler but the redness will remain.
I posed my question on realself but I think the doctors missed the point. Subcision won't work as the scar isn't tethered. Microneedling is something I have tried before. Perhaps laser + filler could work, but I will be pushed to find a good doctor with these skills in my lame-ass country (UK).
https://www.realself.com/question/manchester-gb-scar-revision-failed
Basically my options are:
1. rotational flap
2. skin graft
3. laser+filler
Does anyone have examples of skin grafts for acne scars? That would be much appreciated thanks.
*edited*
I told you this before I think ... You could easily get filler and put makeup over it for color for the time being, there are several other lasers besides vbeam, ipl, excel v, 1064nm, etc. Goto Dr. Chu, hes in London. I would no do any more surgeries. Yes you can subcise and not have tethers, it makes a pocket for the filler. Worry about color after. Then do laser, or tca peels, or dermabrasion on the boarder to get the texture improved.
If color is your main issue put makeup on it, get some concealer that matches .
The reason your getting red most likely is loss of Fat.
I received some more info from my surgeon which I'll post later.
The reason why I don't think it's tethered is basically what the other guy said. There's fat loss basically - a chunk is missing. A ml fat injection is an option but I would then need to find someone who is very good with lasers, which is tough in the UK.
I regret having scar revision for a second time this January. I wasted a lot of time on a procedure that was doomed from the start.
Solution? Simple excision of the scar. Scars like these do well with en-block excision of the scar. Yes, agree, subcision, filler, all the rest can work, but this is in the correct plane for excision. Simple 10 minute procedure, followed by wound care. Scar can then be looked after with tape, silicone, and fi needed fully ablative or NA fractional laser. This scar can be treated with traditional excision methods, and improved with newer technology (lasers). Just my observations...
Here is what the surgeon said to me over email.
Many thanks for your further email. We can reconstruct defects the size of a 50p piece using the piece of skin I am thinking of, so don't worry if there will be enough .
Fundamentally your skin stretches after the sutures come out. This is a problem possibly with the fabric of the scar that you make.
The options are to leave stitches in for a long time which will give you caterpillar tracks. or close the wound with no tension at all, using a flap from your nose.
The third option would be to use long lasting under skin sutures which might work for you and just cut and stitch like we did once before. A graft will give you a second scar where the skin comes from so in a way a longer scar as well.