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ForeverAndPatience

Oh, Wouldn't It Be Nice!

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If people documented more on their treatments with honest input and pictures with descriptions. Especially on excision. I feel like excision could really help some people, but I've found very few posts on it, but more questions than actual procedure recoveries. I know people have their own lives and whatnot, but if I ever decide on this you can count on me to give the most anal description ever! (Oh how my tunny is awkward)

I have questions, just as anyone, but from my research I feel like if your scar bothers you enough and you'd rather have a line scar, why not? Any who... heres one post I found:

http://www.acne.org/messageboard/index.php/topic/243150-scar-excision/?fromsearch=1

And from everything I've read, double stitches are the best. Internal dissolvable stitches and then the superficial stitches. And its best to have it done by a board certified plastic surgeon.

When you get a good cut, that takes a chunk out... whether intentional like scar revision or in an accident, stitching requires you not to stress the wound so it doesn't oper back up. Internal stitches bind the flesh beneath, and we all know what superficial stitches do. So if this is done, from my knowledge of what I've heard and read... you'll need to have the outer stitches out to avoid that polka dot scarring from the suture/ stitches. I hear good things about silicon tape to keep tress off/ lessen scarring. Sooooo... basically you should be prepared, and take hella care of it afterwards. And no weird faces!

I really would like to see more on this. It kind of freaks me out thinking about having something cut out... but, well. Doing nothing... accomplishes nothing. And I'm not one to let things be that bother me. But -not- jumping into anything until I know of any other ooptions. Avoidance would have been best. "An ounce of prevention is worth a pound of cure."

Oh, the truths. How they hurt.

Double oh...There are risks, but what doesn't have risks?

In my mind, it sounds the least damaging if its done right. Lasers scare me. I've never had stitches though. I did literally come out of the hospital from an accident that messed me up, but I didn't need stitches. Just mad lacerations... and contusions. (God, I hate hospitals. Five hour wait to just be wrapped up!)

But anywho, if anyone knows anything more about anything else relating. I know only so much dx

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It looks like we're researching the same thing, ForeverAndPatience. smile.png

I've concluded that excision is a very effective treatment - basically a one-and-done solution - if everything goes well. I'm interested in trying it for my most recent scar - and if I'm happy with the result, possibly some others, too.

If it goes well, you would still in essence be trading one scar for another, but in the best-case scenario, the new scar would be fairly unnoticeable except on close inspection. It could even be practically invisible. The thing that does worry me, though, is that the new scar would be hypopigmented, which is always permanent. So, if it goes badly and the resulting scar is bigger than you'd like and noticeable, the only way to try to fix it would be getting more excisions (or possibly stem cell treatments, which would be too expensive for most). So there's no going back. If the surgical scar is indented or hypertrophic, you could have other types of treatment to level it off, but nothing would fix the hypopigmentation apart from another excision (trading it with a hopefully smaller hypopigmented scar).

To ease one's mind though, this is pretty much the same thing as getting a mole surgically removed from one's face. Plastic surgeons do it all the time. After reading some mole removal experiences, most seem to be happy with the scar and say that it isn't noticeable once it has fully healed. So the chances of everything going well, especially if one takes all the precautions, seem pretty good. We're lucky in the sense that facial surgical scars tend to heal very well, unlike elsewhere on the body.

This is what I've found based on miramar's (and a few others') posts:

- Get a good experienced plastic surgeon (of course), which is the most important thing. Derms or GPs might do excisions and even get good results, but they may not be that experienced and you really don't want to take the risk.

- A scalpel excision (an elliptical cut) as opposed to a punch excision (a round cut) seems safer, since the tension on the excision scar would be less intense and thus the scar is less likely to widen or rip open during healing. This though would mean a longer incision and a longer scar, but it seems worth it. As far as I understand, punch excisions aren't very common at all, except when treating acne scars (and usually by a derm).

- The excision needs to done according to natural relaxed tension lines on the face. They basically tell you which way the line scar should be for there to be minimal tension, and thus the best chance for a good cosmetic outcome. This may mean having to make a longer incision, if the scar is "facing the wrong way". I'm lucky because my scar is already aligned to the natural tension line, so the excision wouldn't have to be that much longer than the scar.

http://www.merckmanuals.com/media/professional/figures/PHY_skin_tension_lines.gif

Some surgeons use Langer's lines, which is the outdated method. These actually are based on tension lines on cadavers' faces and they don't correspond with the tension lines on a living person's relaxed face. There are a few areas on the face where the Langer's lines are completely opposite the relaxed tension lines, and you should make sure your surgeon is not using Langer's lines and is planning to make the excision in the right direction.

More information:

http://rlbatesmd.blogspot.fi/2011/07/should-langers-lines-be-used-for.html

- Get external stitches removed by day 4-6 to avoid them denting your skin. The longer they stay, the less likely it is for the wound to open up, but then the more likely it is that the stitching leaves scars. So it's a trade-off, and leaving them for 5 days or so seems ideal.

- Use steri-strips, micropore or some other tape on the scar for at least five weeks (or a few months, to be on the safe side) after the stitches are off. This is to relieve the tension on the scar, making it less likely to widen or open up. Apparently the tape is fairly unnoticeable, so for one excision, this shouldn't be too big a deal.

- Miramar recommends an "everted closure", lifting the edges of the excision higher than the surrounding skin, and a "mattress" suture type of stitching. I haven't looked into these yet, and I haven't found out if most plastic surgeons already use these techniques or not. I hope they do.

- I don't know if internal stitching is necessary for smaller scars, although it would seem safer to have internal stitching in any case. However, there are some cases when the internal stitches have caused complications, and e.g. come out of the scar. It would be wise to get internal stitches at least if you're treating a bigger scar though.

- Excision seems best on isolated scars, and scars that are small and deep. Bigger scars can be treated as well, but there seems to be more of a risk of the scar being more noticeable. Smaller scars tend to heal better, because there's less tension. Ice-picks would respond best, but it seems suitable for small boxcars as well. If treating many scars with excision, it would be best to do one at a time, if they're in any way close to each other. If something goes wrong, re-excising the scar is possible after about 5 months.

That's all for now, but I'm still researching. smile.png I'd like to get consultations with a couple of plastic surgeons and also question them about their techniques beforehand (shame consultations are so goddamn expensive here, too).

If there are people here who have done excision, it would be great if they could share their results here - especially after the scar has fully healed (6-12 months). But if you can't find anyone, ForeverAndPatience, you could try to search for stories of surgical facial mole removals to get some kind of an idea of what to expect.

Edited by austra

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I forgot to say, ForeverAndPatience. I still think your scar is so shallow that it's not worth excision. But you could try to consult a plastic surgeon and get their opinion on whether it would be worth it. Your one forehead scar - whether it's very shallow and wide or a surgical line scar - isn't really the kind of thing that would cosmetically affect you much, in any case.

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I forgot to say, ForeverAndPatience. I still think your scar is so shallow that it's not worth excision. But you could try to consult a plastic surgeon and get their opinion on whether it would be worth it. Your one forehead scar - whether it's very shallow and wide or a surgical line scar - isn't really the kind of thing that would cosmetically affect you much, in any case.

Yeah. I understand that my scar is... not as bad as it could have been. Its all good that its flat. But the part that bothers me is the placement and how rough it makes my skin look. And in harsh lighting, it looks really bad. And even just looking at it, I just get all these bad feelings and whatnot. I'd just rather have a line scar. I cant even put makeup on this thing .-.

I have a boxcar inbetween my eyebrows that I dislike as well. These aren't my only scars, but they're the ones I want to change.

And thanks so much for the information!

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I'm just bumping this, so it doesn't get lost.

It's such a shame there aren't more people here who've tried excision and could tell us how it worked out for them.

If your scar is very shallow, ForeverAndPatience, maybe you could try dermastamping it for a few months (once a month), and see if that makes it better? There's a good chance the improvement from that alone would be enough, and in any case it could be that the scar wouldn't bother you at all once it's fully matured. So you shouldn't excise it unless you're absolutely sure.

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I'm just bumping this, so it doesn't get lost.

It's such a shame there aren't more people here who've tried excision and could tell us how it worked out for them.

If your scar is very shallow, ForeverAndPatience, maybe you could try dermastamping it for a few months (once a month), and see if that makes it better? There's a good chance the improvement from that alone would be enough, and in any case it could be that the scar wouldn't bother you at all once it's fully matured. So you shouldn't excise it unless you're absolutely sure.

Yeah. I'm kind of scared of needling. Plus I'm in and out of my doctors/ psychiatrists and I dont want them baker acting me lol. They would wonder what the red raw spots are and think its some crazy form of self harm > .>

But, I'm thinking about getting bangs and trying to let my skin chill. The trinessa is working, but I still have my bad habit of picking. Oh, and I just got put on Zoloft.

Ugh.

But later on I'm thinking about having it excised if I can. I mean I dont see why not. Its not depth that bothers me, its the size. Its not huge. Its 5mm I think. I'd rather have a line scar. I think they're cool. I'd actually be proud to have a scar like that. Oh I sound mental. But perfect skin is not gonna happen... sadly

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I found a rather interesting video of a mole excision:

I didn't like hearing that you could need dermabrasion, laser or cortisone injections afterwards to get a good result. saywhat.gif Most experiences I've read of well turned out mole removals certainly didn't mention those, so I'm hoping this isn't normally necessary. But it did make me a bit nervous. I think I'd like to get find a really good and experienced plastic surgeon if I get it done.

Also, having the excision scar three times the length of the original scar does seem pretty long. I wouldn't mind it with the scar I'm considering for excision, since it's only 2-3mm long and 1mm wide, but it may make me hesitant to try it on other scars.

Btw, Dr. Lam seems to have fairly controversial ideas. He thinks subcision and all lasers are useless, and silicone injections and TCA cross are the best treatments out there for acne scars. Hmm.

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I had some scars excised today, I went to my plastic surgeon for a different reason and he said he might as well excise some scars. Previously other doctors tld me the scars werent deep enough for excision and that TCA cross or laser would be better so i dont know how the outcome will be. I had 5 or 6 scars cutout with a scalpel will have the sutures removed in 5 days.

I will post more pics including "befores" when i heal.

post-165434-0-69427500-1359657093_thumb.

post-165434-0-53657100-1359657105_thumb.

post-165434-0-69427500-1359657093_thumb.

post-165434-0-53657100-1359657105_thumb.

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Ah, brilliant! Please keep us posted. Hope they turn out well. :) They look very neat in your picture.

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I had some scars excised today, I went to my plastic surgeon for a different reason and he said he might as well excise some scars. Previously other doctors tld me the scars werent deep enough for excision and that TCA cross or laser would be better so i dont know how the outcome will be. I had 5 or 6 scars cutout with a scalpel will have the sutures removed in 5 days.

I will post more pics including "befores" when i heal.

IMAG0097.jpg

IMAG0098.jpg

Sweet! Thanks for posting. May I ask what kind of scars were they, and how many millimeters were they? Did your surgeon tell you whether he did a double layered closure? Did he explain anything? Just curious. Thanks (:

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Sweet! Thanks for posting. May I ask what kind of scars were they, and how many millimeters were they? Did your surgeon tell you whether he did a double layered closure? Did he explain anything? Just curious. Thanks (:

They were shallow boxscars, not icepicks. they varied in size, maybe about 1.5mm long and not too wide. He only sutured the outside of the skin, ill post pics of the stiches once i get the dressing removed.

Edited by oopli

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Oh cool. That's just the kind of scarring I mostly have (and am considering excision for). Did he give you any after-care advice? Like use microtape on the excision scars to support the skin etc?

Happy healing! I'm very excited for you.

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ok i got the stitches removed yesterday, it actually hurt and the excisions bled a bit, i dont know if this means they opened but all the excision sites bled. Hopefully everything heals ok but i am a bit worried because i dont think its normal for the excisions to bleed. Anyway the doctor put steri-strips over the them and told me to leave them on for 5 days. I'll update with pictures when I remove the ster-strips.

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Thanks for keeping us updated. :) I don't think the bleeding necessarily means anything bad, it could've been just from removing the stitches. Hope everything goes okay!

I just read somewhere that one shouldn't have comedonic or inflamed acne near the site of the excision, because it increases infection risk. Which was a good point and something I at least have to take into account if I have this done.

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I circled the scars that were excised, the middle pic is on day 3 and the rightmost pic is day 7. I am now on day 11 and it looks pretty much the same except less scabbing. I still keep them covered with clear tape all day and plan to do so for another few weeks since i read it helps relieve tension. I dont think ill be able to judge the final result until around 2 months time so still have a ways to go.

post-165434-0-60498000-1360635095_thumb.

post-165434-0-60498000-1360635095_thumb.

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Thanks for the update! I agree that you can't fully judge the results for a couple of months, and I would also keep the tape on them for a few weeks. So far the one incision line that is not under a tape in the third picture looks very neat though.

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Wow, you're brave! I hope everything turns out well. The doctor managed to make the procedure sound so casual. "Ah, while you're in the neighborhood lets just cut some holes in your face and stitch em' back up" ;)

Nonetheless, I wish you the very best!

And as for the OP, thanks for the heads up. I've been contemplating scar treatments for a while, but I think I'll put that to rest. The fact remains that we are unable to see what others do, and our scars will always be magnified in our eyes until we manage to shift our perception.

I can tell you for one, my scars are pretty noticeable (to me anyway) but I still manage to go on a lot of dates and meet a lot of new friends. Just goes to show, us acne/ scar sufferers MUST have the best personalities once we learn to look past our own flaws and decide to be confident based on our other features.

Ah, well I will remain praying for you all. And as for you GUYS out there suffering with acne scars, put it to rest! I for one, think it gives you a certain rugged, manly appeal. Pretty boys are SO overrated. rolleyes.gif And girls, rock what you got! You're confidence and grace will win em over every time. Stop being so hard on yourself. So what? We don't look like these primped up barbies with 9 times out of 10 ugly attitudes. You are beautiful and you deserve happiness just as much as the next girl.

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Hope it's going well for you, oopli! It should've been around 3 and a half weeks by now, so the incisions should've healed fairly well by now, even though you can't tell the result for at least a month or two.

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I've now booked a consultation with a plastic surgeon for excisions! smile.png I was hoping to get the consultation asap, but she was fully booked until mid June. I suppose it's better that way since it gives my new scar a bit longer to heal (now it's been four months). I'm going to ask her opinion on excision for 1-4 of my worst boxcars, and also punch grafts if she's done them before. If she thinks it's a good idea to excise my scars, I'm going to go for it this summer or christmas holidays, and first just excise one scar.

And this is ridiculously expensive, I have to say. I chose the plastic surgeon that seems the best for the job disregarding price. I couldn't find anyone specializing in surgical acne scar treatments (not surprisingly), but this one specializes in skin cancer surgeries and scar corrections, among some other things. The clinic where she works charges over 130€ for the 30-minute consultation. And it's in another city and I have to take a 2-hour train to get there, which also isn't cheap. But I guess it's best to do this properly if it's to be done.

Edited by austra

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I consulted with a plastic surgeon about excision of a huge scar (about the size of a dime) and he refused :( Said the outcome wouldn't be any better than what i have already. I feel like that's subjective. The scar I have now is a reminder of what happened and I want it gone or changed! I see the excision in stages thread, I would be willing to do that if someone would for me. My scar is by my mouth (in my smile line) so I think he thinks I'll rip it open or it will widen. I will not smile or eat solid food for 6 months if it means getting rid of it!

Good luck austra I hope your consult goes better.

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Thanks! I don't really know what the plastic surgeon will say, I'm worried she'll tell me that excisions wouldn't give me improvement. We shall see.

If you're talking about the same indent you posted in the other thread, I would agree that it's not really suitable for an excision. Firstly, you're likely to get a lot of improvement with less invasive methods - the indent might fill on its own once the cortisone effect wears off, or you can get subcisions and fillers which should be effective for that type of scarring. Excising a very large scar near the mouth area is indeed quite risky, and you might regret the end result if you went through with it.

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its been 4months since the excisions and honestly the scars look the same, its weird how the excisins can heal and look exactly the way the scars were-almost as if the skin has some type of memory. Anyway even though i didnt really see an improvement im grateful they didnt turn out worse.

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