I am over 5 weeks post Scar revision, reaction to sutures causing raised thick bumpy scar. 1 plastic surgeon recommended scar revision the other cortisone injections. The scar is quite disfiguring as I can't wear makeup to even cover it up, it highlights it more since it is so raised, think and bumpy.
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I posted a question recently about a problem I'm having with a scar revision that I had over 5 weeks ago. I have a severe suture reaction to the pds absorbable sutures which were placed too close to the skin surface. I had the scar reivsion by a surgeon outside of my area that specialized in geometric broken line revision. I liked his before and afters and it appeared he did them all the time so that is why I went to him. He recomended me to just wait it out things will get better. The scar has become thick, raised and bumpy even though the incision line is very thin. It is 2cm and is right in the middle of my cheek. The scar was originally due to a cosmetic mole removal from 10 years ago. With the advise I got from my prior post, I decided to go to see 2 local plastic surgeons. One of them first recommended a surgical scar revision and said he wouldn't do this normally, but this isn't a normal situation.He told me I need to get the sutures out ASAP as I am having a sever reaction to the foreign body. He said it is so red it looks like an infection so he put me on antibiotics first. I paid him 600 deposit up front half of the 1200 fee as I was desperate to get these sutures out. Then when I asked him after I padit he deposit if it is too early to do surgical scar revision he said he wasn't doing surgical scar revision so now I'm totally confused as I paid full price for surgery scar revision. I emailed the office to ask can I get my money back. I think I will go to a few more plastic surgeons to get their advice but my gut tells me to cancel this appointment. The other surgeon recommended cortisone injections. I'm so terrified of them though as I've heard they can cause atrophy and whiteness of the skin. I've heard that 5-fu is better where it can flatten scars without the risk of atrophy. What is your opinion on this? It seems like there are hardly any surgeons who use this though it's hard to find one. Also do you think it's too early to have another scar revision done? My gut tells me it is but this is a highly unusual situation since I'm having such a bad reaction to the sutures which is in essence causing me to have a very obvious thick and raised hypertrophic scar.My worry is that once the scar becomes thick there is no way to get it to be a thin line again.
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Scar care after surgery begins at the time of surgery. Incision placement, tension, and suture placement all factor into to scar quality. Scar healing can take upwards of 2 years. The surgical incision after plastic surgery can look everted and raw for a period of time and the key to healing is allowing for the initial strength of the incision to build over a 6 week period prior to do much of anything. I like to start scar care at the 3 week point if appropriate with silicone, sunscreen, and scar massage. Reacting to an early scar is normal, but can hurt the scar healing. Suture reaction is common, especially at the 5 week point when your body is digesting the suture material. Plastic surgery scars will heal and usually will not need a tremendous amount of injection and other invasive modalities, other than patience.
The fact that you needed a scar revision implies that your healing mechanism are hyperactive, causing unacceptable scaring. No matter what kind of geometric closure is performed the progression of your healing needs to be managed with immune modulators such as steroid injections or 5 FU, or localized radiation. The spectrum of scare formation from hypertrophic scarring to keloid formation represent very difficult situations for patients and doctors. The fact remains that the science behind treatment options for this problem is vague and unpredictable. Best results are often achieved when the physician follows you on a close interval after surgery for an extended period of time (months). This may be every 2 weeks in order to judge whether you need immune-modulator or not. The typical regimen that we use is a combination of steroid and 5FU with dilutions that help manage the acute hyper inflammatory phase. Use of lasers in specific circumstances can also be useful - specifically Erbium Pro-Fractional Laser. Silicon Gel Sheets are know to play an important role in managing longterm scar remodeling and need to be used on regular basis to see results. Cordon tape may also be useful in mild cases of scar inflammation but the degree of control of the inflammation is not as accurate. It is correct that steroid injection can cause atrophy and hypo pigmentation, therefore, the patients needs to be informed of the potential risk of each treatment option. A right balance and approach to scar revision is a timely process and often requires more time than surgery itself, making it frustrating for both the patient and the doctor. Because of the long term issues involved with the care of a scar you need to have a local physician to manage this problem for you.
This scar represents a troubling situation. Unfortunately, some scars continue to worsen for up to 6 months following an injury. I generally tell my patients that they cannot judge a scar for approximately 9 months to a year following surgery. It takes this amount of time for a scar to mature. I cannot judge the quality of your scar without seeing it. However, I can say that I have had experience with 5 FU. Kenalog is a corticosteroid that is very commonly used with hypertrophic scars. 5FU is uncommonly used. This means that few people have experience with it. It involves an injection of diluted 5FU beneath the skin. We researched this material and used it while I was in residency. In our series of 4 cases, it did not appear to improve the scar, and in 1 case, it caused a wound to open entirely. I hope this helps
"Scar revision".....scar revisions are a tricky propositionas is its hard to gurantee the outcome. Taking the conservative and more controllable route may be better. The steroid injection doses can be modified and diluted so that you can start slowly and manage the results. Also we often use a milder medicated topical Cortisone TAPE that has 'Cordran" on the sticky side, using it on the scar nightly starts softening it and making it less bumby, after which gentle injections can be started on a monthly basis. We use this on Keloid scars with good success.....GOOD LUCK!
I have not seen an allergic reaction to PDS sutures and wonder if you confusing that with an infection, which it sounds like you had this addressed with antibiotics. It sounds like the sutures were too superficial exposing the underlying tissues to bacteria. These should be removed and area allowed to heal. During this, you should use a silicone based scar cream, sunblock and UV radiation avoidance to the area (shade, umbrella, hat, etc.).
You may also be a keloid scar former. This is a condition typically seen in African Americans and Native American Indian descent and causes too much scar formation for a given injury or surgery. The resulting scar is beyond the original boarders of the surgery or injury. The treatment is excision, fine atraumatic closure, and steroid injection directly into the scar (not surrounding tissues as to avoid the atrophy you mentioned).
Typically, scars are improved by surgically excising them (cutting them out with a scalpel) and preforming a plastic surgical closure. Other modalities include dermabrasion which involves a sanding of the scar (I do not recommend this), steriod injection, lasers to help with discoloration issues, and silicone cream application. Keep in mind that there is no way to erase scars. The goal is to make them less noticeable, in other words, trading one scar for one that is more favorable in appearance.
You may also be a keloid scar former. This is a condition typically seen in African Americans and Native American Indian descent and causes too much scar formation for a given injury or surgery. The resulting scar is beyond the original boarders of the surgery or injury. The treatment is excision, fine atraumatic closure, and steroid injection directly into the scar (not surrounding tissues as to avoid the atrophy you mentioned).
Typically, scars are improved by surgically excising them (cutting them out with a scalpel) and preforming a plastic surgical closure. Other modalities include dermabrasion which involves a sanding of the scar (I do not recommend this), steriod injection, lasers to help with discoloration issues, and silicone cream application. Keep in mind that there is no way to erase scars. The goal is to make them less noticeable, in other words, trading one scar for one that is more favorable in appearance.
First, have someone remove the sutures that can be easily accessed, usually through a tiny stab incision. While using silicone scar gel or sheets, find a surgeon who has (and knows how to use) a profractional laser. My preference is a Sciton erbium profractional laser. Remarkable scar improvements are possible with this laser, in the right hands. It is not necessary to wait until the scar matures. Treatment can be started immediately. Goo luck.
It's extremely rare to have this kind of reaction to PDS, usually I would recommend to wait at least 12 months before any surgical revision; meanwhile you can use steroids or scar gels to help the scar since it will change it's appearance during the scar maturation process, which lasts 12 to 18 months
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