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Scohr

Tethered nodules after subcision

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i had a subcision many years ago with excellent results. However recently I had a few rounds of subcision around my smile line for a couple scars and it seemed to just make things worse. The area where the needle was inserted created a tethered area and itcaused additional wrinkles and crooked smile lines. It basically looked like the skin was stapled along the three points the doctor insterted the needle, causing a brand new fold/wrinkle.

I tried to get it fixed, and went to a new doc, who suggested further subcision. This resulted in nodules and further tethering around the smile line. I saw the doctor again a month later, and he went ahead and subcised under the same nodule! He seemed to be wanting to promote more scar tissue (which I understand is a goal in some acne scar subcicions). It's been 2 months now, and nodules haven't gone down much. 

I know kenolog is the popular choice for nodules, but I'm worried it would make the wrinkes worse? I may be crazy but I'm thinking a subcision with a very fine needle might do the trick in terms of untethering all the scaring I've developed. The nodule isn't too high and is only noticeable because it stays in place when I smile.


Anybody have any advice and experience on nodules and additional scar tethering caused by subcision? Kicking myself because the original acne scars were really not that significant.

Edited to add pictures: the top arrow is a straight up needle hole/divot (no nodule, don't care about the hole, do care about the crescent wrinkle it creates), second arrow the nodule is about 1 month old, 3rd arrow is about 2 months old. The red marks in the first picture are holes from the insertion of the needle.

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Edited by Scohr
added photos

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It appears to be more tethering that has pulled the skin together, creating the bulged look. Additionally, your body most likely over-produced collagen (over-correction) and it added to the raised look you have now. Perhaps kenalog/ cortisone shots to cause atrophy to those areas would be a good option for you. I'm so sorry you're going through this. 

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13 hours ago, Scohr said:

Anybody have any advice and experience on nodules and additional scar tethering caused by subcision? Kicking myself because the original acne scars were really not that significant.


If your main concern is to lessen the appearance of the nodules, then I suggest you get filler to elevate the surrounding area to even out with the nodule.

If your concern is with the tethering, then you will need to get another subcision--but with filler this time to avoid possible retethering.

As such, in order to combat both problems, I would suggest you get SUBCISION + FILLER. 

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This looks like the veins were chopped up, take vitamin K.

Stop all filler and subcision here. Get your filler dissolved with Hyaluronidase.

There is major arteries here. Who knows if they chopped these up to shreds or the vascular system here. We do not fill this area anymore, we fill the cheek and pull it up.

You need to let this area heal, the collagen is torn up by two subcisions. The filler was probably pushed to the side and made things worse, this is why the nasolabials are not filled anymore!

This will take months to heal.


Non-surgical Rhinoplasty - Aesthetics

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Thanks the responses guys, so I'm getting a few conflicting recommendations. Should i just wait everything out first and then try subcision+filler or is filler bad? The bottom two pictures I was grimacing so the bulging is is more accentuated (still there but not quite as obvious). Im guessing I should wait things out a few months first before I try anything else?

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You have skin / vein, damage, let it heal. The posters are giving you general advice, we are not your doctor, plastic surgeon. This is not acne scarring.

See a board certified aesthetics doctor if you wish. Look at the anatomy picture I posted, you do not subcise here! Filler is not used for the nasolabial folds, they inject the upper cheek, to pull it up. This is a very dangerous area to go messing around in. Make sure the doctor is very experienced. 

Nodules are injected with kenalog, have a dr take a look if you feel they are keloids, I frankly don't see nodules, but I cannot see you in person to check. To me it looks like you had skin there broken up and potential vein issues around this area.

Again filler is not injected here "normally", if they did this please have  Hyaluronidase dissolve it, it was most likely pushed to the side if that is the case. They might be able to do a fix by putting a bit of filler around it to counter it but it is risky, again someone with experience using a cannula to avoid the veins.

It will take some months to heal again.

Non-surgical Rhinoplasty - Aesthetics

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I see, thanks. As long as it hopefully heals in a few months... I think I see what you mean. Just did some research on track marks and it does look sort of similar 

Edited by Scohr

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1 hour ago, beautifulambition said:

You have skin / vein, damage, let it heal. The posters are giving you general advice, we are not your doctor, plastic surgeon. This is not acne scarring.

See a board certified aesthetics doctor if you wish. Look at the anatomy picture I posted, you do not subcise here! Filler is not used for the nasolabial folds, they inject the upper cheek, to pull it up. This is a very dangerous area to go messing around in. Make sure the doctor is very experienced. 

Nodules are injected with kenalog, have a dr take a look if you feel they are keloids, I frankly don't see nodules, but I cannot see you in person to check. To me it looks like you had skin there broken up and potential vein issues around this area.

Again filler is not injected here "normally", if they did this please have  Hyaluronidase dissolve it, it was most likely pushed to the side if that is the case. They might be able to do a fix by putting a bit of filler around it to counter it but it is risky, again someone with experience using a cannula to avoid the veins.

It will take some months to heal again.

Non-surgical Rhinoplasty - Aesthetics

Thanks for posting this.  Does this mean that atrophic scars on the chin (in the area of the artery) would be unsuitable for subscision?  

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@motherofms Your doctor will know where he can and cannot treat and the signs to look for in arteries and veins. It depends how thick the skin is and what plane he is subcising in.  I have seen many cases on the chin where botox works better to relax divots, sometimes a bit of filler. The above Op you can clearly see the skin thinning (needs to heal) and that is what I wanted people to be aware of, not for fear of subcision. He could have some inflammation and damage of the veins that just needs to heal or be injected with steriod. This is why anatomy is so important, but it can vary on all of us a bit. See a board certified doctor and you will be fine.  

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Thank you @beautifulambition.  My doctor has agreed to subscision of one of my worse scars as a test case.  It's in this area.  That's why I'm asking. Thank you for your helpful and reassuring reply.  
 

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