Scar Revision Dallas

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Scars on the nose are truly a unique problem that differs from scars on the face for many reasons. First, scars in the lower two-thirds of the nose, especially the lower-third of the nose are hard to close if they are wide because the nasal tip skin is very tight and adherent to the underlying cartilages. Interestingly, the cartilages in the lower third of the nose are very mobile making you think that the skin is loose too but the skin is actually quite tight. The skin becomes progressively more mobile going upward to the top of the nose, as the nasal structures underneath become progressively firmer and harder. If you run your finger up and down on the nasal skin, you will see that you can easily slide it up high on the nose and somewhat ok in the middle and almost not at all along the bottom third of the nose. With this issue in mind, scars must be addressed in a way not to allow tension to occur in the nose when the skin is closed or the scar will widen. In addition, in the nasal tip, removing too much tissue can cause distortion to the nasal tip and particularly the nasal ala, i.e., the nostrils.

Scar Revision Procedure

To manage this situation of very tight nasal skin, a special kind of undermining of tissues must be performed to achieve a tension-free closure without distortion to the surrounding skin and cartilage. The incision through the skin must be carried down through the muscle layer with undermining or release performed at the so-called sub-SMAS layer, i.e., below the muscle layer and above the periosteum (lining of the bone). The mistake is to make that incision simply under the skin where the tissues may buckle, the blood supply be compromised, and the skin stretch back to widen the scar. With too much tension, a rotation flap of tissue borrowing from areas of freer tissue may be needed to release the tension or to prevent distortion of tissues. See the section on reconstructive rhinoplasty for some of the principles involved in reconstructive nose surgery. These techniques are critical, especially in the nasal tip for the reasoned mentioned in the previous paragraph. The principle of scar revision requires achieving an incision that is hard to detect. If the initial scar is wide, white, discolored, raised, or depressed, it may be worth considering a scar revision surgery. To make a linear scar appear less obvious, the preferred method is known as a geometric broken line repair in which the scar is irregularized into tiny trapezoids, triangles, and squares so that a viewer of the scar cannot visualize a straight line making it hard to actually see the scar from a social distance.

Diagramatic representation of geometric broken line closure

In addition to excellent surgical technique, other supportive measures may be important to achieve great results include Botox injections for optimal scar healing, mechanical dermabrasion to soften linear edges of the scar, and possible 5-fluorouracil injections to manage any raised scars. Dr. Lam believes that excellent scar revision involves both superior surgical technique as well as diligent after care. For his out-of-town patients seeking scar revision, he can Botox the area the day before the surgery (to minimize stretch back of the tissues), Botox the day of the procedure to help with the scar tissue, then you can leave that day or the day after depending on whether you receive any sedation. Typically, Dr. Lam uses dissolvable sutures so you do not need to stay in town. However, if you can return in 1 to 3 months for fine tuning and possibly again at 6 to 12 months for possible dermabrasion or other interventions that would be a good idea. For his in-town patients, Dr. Lam will adjust the follow-up schedule depending on how the wound is healing. Another important technique change that Dr. Lam has instituted in the past 5 years is in the past he would use a much longer dermal suture (deep buried stitch) and a shorter-acting, removable skin suture. However, he now believes the reverse is better where he uses a shorter-acting deep suture and a longer-lasting skin suture. The reason for this change is that the deeper suture can at times spit out through the wound so using fewer of these sutures and shorter-acting ones limits this issue. He now uses a very fine dissolvable suture that is as thin as a hair and white in color that stays for several weeks. It not only does not leave track marks but holding the epidermis together longer leads to better healing and less risk of the wound spreading back. Botox adds extra healing effects along those lines. In addition, by using dissolvable sutures, patients from out of town do not need to return for suture removal. Finally, with dissolvable sutures, Dr. Lam can add many more sutures to finesse the incision without worrying about needing to remove all of these fine sutures. He does that to make small adjustments as need be. In summary, Dr. Lam is a skilled surgeon in all types of scar revisions but that takes a special skill when performing nasal scar revisions for all of the reasons enumerated above. You will understand more of Dr. Lam’s technique specifically as it relates to you after a consultation with him.

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Your Scar Revision will be performed by Dr. Lam' surgery center located in Plano, TX.

Dr. Lam did my nose on June 2nd. My mom went to him before me. I wanted the rhinoplasty to make myself look better. Dr. Lam is really nice and thorough, plus he has a really nice office. The recovery was easy, no crazy bruises, and after a week, no one could tell I had surgery. I have already recommended Dr. Lam to someone else.

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