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tabula_rasa

scar excision widened

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Hi.

Has anyone had excised acne scars widen? Are there any special surgical techniques that can prevent/minimise this?

Years ago I had a largish (10 x 4mm) cystic acne scar on my cheek revised by a PS. but within weeks it widened and became red and sunken. (I used temporary fillers since).

I am thinking about whether to attempt revision again.

A dermatologist said excised acne scars often fall apart... that the subcutaneous tissue for some reason does not bond well. He said there is a high chance it will fail again.

Another PS has proposed a W plasty without subcutaneous sutures to minimise inflammation. This would make the scar longer, so if it then fails it would be sustantially worse.

If you have experienced these difficulties I would be grateful to hear your comments....

Cheers :)

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I had 10 cut out and only two worked for me. Now I have 5 of them that got wider from doing TCA peels and now they look bad. I have gone to a PS and he just wanted to cut them out again. He told me nothing else would help and that I would be wasting my money on lasers and fillers. I will not let them cut me again, I have an appointment with a Derm next month who has the new Affirm laser. I will see what he says. This is just my results as you know everyone has different outcomes some good some bad.

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I had 10 cut out and only two worked for me. Now I have 5 of them that got wider from doing TCA peels and now they look bad. I have gone to a PS and he just wanted to cut them out again. He told me nothing else would help and that I would be wasting my money on lasers and fillers. I will not let them cut me again, I have an appointment with a Derm next month who has the new Affirm laser. I will see what he says. This is just my results as you know everyone has different outcomes some good some bad.

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Many pages back on the fraxel thread Troubled Skin posted advice on how to stitch to avoid separation and possilbe remedies for failure. He is a doc and his advice seemed sound. Hope you find the posting.

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Many pages back on the fraxel thread Troubled Skin posted advice on how to stitch to avoid separation and possilbe remedies for failure. He is a doc and his advice seemed sound. Hope you find the posting.

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I had an excision of a large scar, left me with an approx. 1" linear scar - still indented. I had spot CO 2 which helped soften the sharp borders, recently i had fraxel which helped lessen the depth and smooth the scar, easier to cover, but still indented. Will be having plasma treatment on 4/9. I'd say in some ways my scar is wider, but it is not as deep of crevice. A little wider, yet flatter. I'd rather have a wide, flat scar than a narrow crevice scar.

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I asked my derm about using long lasting stitches suggested in that paper by T Mustoe for scar excision.

His response was:

"You need to clarify the anatomical areas that Professor Mustoe was talking about in his paper. The use of long term subcuticular polypropylene or permanent clear nylon sutures typically is on the trunk to prevent scar spread there. Such long lasting sutures typically are not used on the face. Long lasting dissolvable sutures are available, again these are typically used on the trunk and they would be quite infrequently used on the face because they typically remain “bumpy†until they can slowly dissolve."

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I am not going to have mine re-revised. I have opted for a filler again - Sculptra, and some V-Beam for redness. My derm's advice was that unless there is a clear reason why it widened (like infection, or sutures breaking) suggesting a different approach then it is quite likely to happen again.

In my case the excised scar never broke apart, but simply became red and depressed in an eliptical shape (probably exactly the shape of the excision). It seems from many accounts this does often happen but the explanations of what causes it vary from surgeon to surgeon: 1) the subcuticular sutures dissolved too quick 2) that the subcuticular sutures caused inflammation 3) that glandular / acne skin sometimes just doesn't want to join back together. 4) that it was not properly undermined from surrounding tissues and stretched 5) that it was not meticulously sterile.

I was ready to have a W-Plasty with long lasting sub-cuticular sutures. But then the majority of PS / Derm's I saw said they wouldn't touch it if it was their face.

A re-revision would create a larger excision, and so if it failed the result would be worse still. I had a filler in it before, it worked fine and I was perfectly happy for 3 years. It isn't that big or depressed - about 10 x 4mm ellipse and red. I think it's more the frustration of not understanding why it won't hold that bugs me! I have had scars from sporting injuries stitched up and hold just fine.

When this filler wears off I could revisit the whole question if I choose. Also, as you get older your skin becomes more lax and easier to stitch together. Or there may be superior fillers at that time.

If you are having scars excised for the FIRST time then it is almost certainly worth a try, at least on one or two to begin. But if they fail, then it seems re-excision carries an increased risk that they will fail again, and then be worse. Whether to use long lasting subcuticular sutures or not .... I don't know!

Anyone looking into excisions - please let us know what your doctor says, what you decide, and how you go.

And anyone who has a re-excision of the same scar, we really want to hear from you.

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