Several key variables will dictate the ideal scar revision facelift techniques, the most common of which include Kenalog injection, direct excision, laser treatments, dermabrasion, hair transplant, among others.
All facelift incisions are placed within the ear’s contour and behind the hairline to hide the scars, although excessive tension on the skin at the time of surgery and poor healing can lead to scar migration or thickening. Nevertheless, poor scarring is extremely rare when the surgery is performed by a qualified facial plastic surgeon.
Timing is one of the most critical aspects of scar revision surgery. Should the patient require an excision-based procedure, predictable results are achieved if she waits nine to 12 months, allowing the scar to attain its best possible appearance—i.e., soft, flat, and faded.
Nonetheless, many facelift surgeons in Los Angeles plastic surgery still treat “immature” scars (about three weeks after surgery) with topical treatments such as silicone creams and tapes, massage, and compression.
Simply put, a more invasive scar revision facelift, i.e., excision-based surgery, is viewed as the last resort because it comes with risk of worsening the scar appearance.
However, some forms of scar revisions, particularly if they involve lasers and chemical peels, provide better results when the scars are still in their remodeling stage, thus making it ideal to start such treatments within eight weeks.
Aside from timing, another critical aspect is the appearance of scar. Plastic surgeons take into account these three most important facets: its height, weight, and color. Should the scar appear raised or thick, most prefer Kenalog (steroid) injection, scar massage, and/or silicone sheets in the first 3-6 weeks.
Kenalog injection comes with a risk of soft tissue atrophy/shrinkage (which may result in skin depression and other changes) that it is typically performed about three weeks apart to avoid such problem.
Meanwhile, scar massage is performed in an attempt to break up the scar tissue by pulling, stretching, and kneading it several times each day. Some doctors like to combine it with other treatments such as silicone sheets whose compression is believed to deter excessive formation of collagen closely tied to keloids.
Should the scar remain thick or raised after months of such aforementioned treatments, an excision-based surgery might be considered.
In the rare event that the incisions behind the hairline lead to bald patches that persist for more than 3-4 months, hair transplant surgery might be recommended. It is important to wait for a few months because “hair shocks” typically resolve on their own.
Liposuction skin tightening effects will vary considerably, depending on the inherent skin elasticity, age, lifestyle, treated area, and methods used at the time of surgery, as suggested by renowned Los Angeles plastic surgeons.
Some doctors suggest that laser-assisted liposuction provides more tightening effect than the traditional approach. This technology “heats” and liquefies the fats before a hollowed probe attached to a vacuum pump extracts them.
Proponents suggest that laser, due to the controlled injury to the skin, triggers the body to produce more collagen, leading to mild to moderate tightening effect. But older people (50 years and above) and patients with redundant skin caused by weight loss will not enjoy such benefit.
However, one study has suggested that patients whose skin has a “decent” level of elasticity to begin with can benefit from laser liposuction’s effects.
The subjects have mild skin laxity in their abdomen, with one side treated by laser technique while the other side by standard liposuction.
Three months after surgery, the laser-treated side on average experienced 59 percent “skin shrinkage” compared with the area treated by standard liposuction technique. The researchers used a highly sensitive 3D camera to come up with their conclusions.
Nevertheless, the “operator” or doctor’s level of skills and experience will still determine the postop results, instead of the technique or device used at the time of surgery. The general rule of thumb is to select a board-certified plastic surgeon who performs liposuction on a regular basis for a minimum of five years.
Contrary to popular belief, liposuction is not about removing the optimal amount of fat. A highly experienced doctor can assess how much volume can be removed without causing skin irregularities, gaunt or unnatural appearance, and other signs of botched surgery. For this reason, patients with some mild loose skin may have to accept that only a conservative amount should be removed to make sure that the skin can redrape to the new contour.
Meanwhile, patients with significant skin laxity will need excision-based surgeries such as tummy tuck, thigh lift, upper arm lift, and buttock lift, as opposed to a liposuction-alone surgery.
Sometimes liposuction is combined with excision-based surgeries to achieve a near normal body contour after massive weight loss. While multiple procedures in one surgical setting have their own benefits, on some occasions it is better to stage them to minimize risk of complications.
Facelift scars are well concealed behind the hairline, around the ear’s contour, and within the natural folds of skin. Nevertheless, proper wound closure in which there is little or no tension on the skin is important to prevent scar migration, which is one of the most common concerns of patients.
Beverly Hills plastic surgeon Dr. Karan Dhir says scars tend to fade quicker and better in older patients whose skin is more lax than younger individuals who typically wait 18-24 months for their scars to settle and “mature.”
Most of the healing takes place within two months, although Dr. Dhir advises patients to wait up to a year before they “judge” their scars, especially if they are considering a scar revision surgery.
In the first few days, the wound goes to an inflammatory stage in which it appears swollen and red and is susceptible to infection, although the risk can be minimized by good hygiene, wound care, and possibly use of antibiotics.
The second stage, meanwhile, happens three to four weeks postop in which fibroblasts or cells responsible for forming new skin and other tissue are produced in abundance. At the same time, the injured skin releases collagen to close the wound together and release tiny blood vessels needed for healing.
The fibroblast stage is believed to be a crucial time since scar tissue caused by “faulty” collagen may develop, leading to keloids or hypertrophic scars that appear thick, raised, and discolored.
At this stage, it is not uncommon for doctors to require their patients to use silicone sheets or tapes for as long as tolerated. Proponents suggest that these treatments provide constant pressure that prevents scar tissue or “haphazard” collagen from forming within the dermis.
And because the silicone sheets create a moist environment, they also encourage the scar to heal and fade quicker.
Aside from the use of scar treatments, Dr. Dhir says good nutrition and health plays a crucial role in “favorable” scarring, i.e., fine lines that blend well with the skin and/or behind the scalp. The general rule of thumb, he adds, is to increase protein intake weeks prior to facelift and during recovery as well.
Avoiding smoking at least three weeks before and after facelift also prevents “unnecessary” or “aggressive” scars. Dr. Dhir warns that all tobacco and smoking cessation products contain nicotine, which is known to constrict blood vessels and lead to compromised healing.
Any form of plastic surgery is impossible without the use of incisions, which will inevitably result in scars. Nevertheless, a good surgeon will make every effort to position them within the natural skin folds, beneath the “bikini” line, and other “strategic” places where they are barely detectable.
Some types of plastic surgeries such as breast augmentation, liposuction, and mini facelift use small, hidden incisions that the risk of visible scars is generally not a cause for concern.
However, some procedures such as plastic surgery after weight loss, breast lift/reduction, and tummy tuck require a more extensive use of incisions, thus their scars tend to be more visible, according to Beverly Hills plastic surgeon Dr. Tarick Smaili.
For these aforementioned procedures, Dr. Smaili says the use of scar creams and other related treatments are usually recommended once the wound is clinically healed, which can take three to four weeks for most patients. He warns that using them too soon could irritate the skin or inhibit the healing process, leading to unfavorable scarring and other complications.
Dr. Smaili says a prudent patient will always ask for her surgeon’s permission before using any plastic surgery scar removal treatment. The general rule of thumb is to avoid scar creams on open wound, he further explains.
Dark ethnic skin, according to studies, is particularly prone to aggressive scars or keloid that appears thick and goes beyond the original site of injury. For this reason, patients with a darker complexion may consider scar treatments while their scars are still immature, i.e., less than six months.
Silicone tapes and sheets are believed to be particularly ideal for preventing or treating thick and raised scars because of their gentle pressure and their ability to create a warm, moist environment that promotes good healing. In fact, some surgeons even instruct their patients to use them as long as tolerated.
A good alternative or complement to silicone sheet is scar massage, which aims to break up the scar tissue that may form within the skin surface. Studies have suggested that immature scars, or less than six months to a year of surgery, respond well to this treatment especially when used together with scar creams.
Most popular scar creams today contain silicone and other ingredients known for their hydrating, healing effects.
For stubborn raised scars, Dr. Smaili says steroid injections might be a better option, although they should be used judiciously and must be deep enough to prevent hypopigmentation (treated area turning white) and skin irregularities.
Plastic surgeons might interpret the term facelift surgery differently, although the standard technique mainly tightens the jaw line and upper neck; it has no or very little effect on the mid face and forehead area. Also, the procedure can only address signs of aging caused by skin and muscle tissue laxity.
Meanwhile, facial volume loss, fine wrinkles, leathery skin, and pigment-related problems are beyond the scope of facelift surgery, explains celebrity LA plastic surgeon Dr. Tarick Smaili.
For a more rejuvenating effect, Dr. Smaili says most patients can benefit from facelift with adjunct procedures, which can be performed at the same time or at a later date.
The list below shows the exact reasons why complementing facelift with other procedures can give you more impressive results.
- Take up to 16 years off your face. A 2008 study published in the Journal of the European Academy of Dermatology has suggested that after removing wrinkles from an image, you could be perceived as 10 years younger than you really are. But if your skin is digitally altered to eliminate ugly pigmentation, you could look up to 16 years younger than your actual age.
For this reason, it is not surprising that facelift or any type of facial rejuvenation surgery is typically complemented by chemical grade peels, laser treatments, and other procedures that correct the appearance of dry and leathery skin, sunspots, and other discoloration problems.
- More balanced appearance. Standard facelift only tackles the sagging appearance in the lower third of the face. As a result, your deflated cheeks, forehead creases, and crow’s feet could look more obvious once your jaw line and upper neck have been tightened.
A possible solution is to undergo a full facelift, which is a general term that describes combining standard facelift with brow lift, eyelid lift, mid lift, and/or neck lift—or whatever you really need.
- More natural results. Facelift or any facial rejuvenation that uses skin lift and tissue tightening cannot address loss of volume or fat. In fact, relying too much on pulling and lifting could lead to a perennially surprised or windswept appearance that screams “I have had plastic surgery.”
To avoid the telltale signs of facelift and achieve a more natural result, Dr. Smaili says that loss of facial volume must be addressed at the same time. Dermal fillers injections, fat graft, or sometimes implants, are particularly helpful.
The term 3D facelift often refers to facelift combined with volumizers such as dermal fillers ad fat graft.
While scar massage is not always performed during breast reduction recovery, some patients may benefit from this procedure particularly if they have a strong history of aggressive scarring such as keloids and hypertrophic scars. The idea is to break up the scar tissue or “haphazard” collagen formation while it is still “new” and responsive to pressure and kneading.
Scar tissue develops where the “injury” or surgical incision is placed. Scar massage after breast reduction surgery or any form of plastic surgery must be only attempted once the wound is completely closed and there is no scabbing present. Performing it too early might lead to healing problems and poor scarring. (The photo below shows faded scars about a year after surgery.)
The idea of scar massage is fairly simple. Stretch the skin next to breast reduction scars using two or three fingers, or use a circular motion in a clockwise and counterclockwise manner, to break up the scar tissue.
Another alternative to stretches and circular motions is called transverse friction massage. The idea is to massage the scar line in a direction that is perpendicular to it.
Oftentimes, scar massage is performed five to ten minutes about three times a day, although it all depends on the surgeon’s instructions and type of surgery.
Doctors or physical therapists will instruct their patients on how to properly massage the scar tissue and make sure the surgical site is healing properly, thus follow-up visits are crucial during breast reduction recovery.
Proponents of scar massage often recommend lubrication—i.e., silicone lotions, gels, and creams—to further break up the collagen within the dermis and hydrate the scar, so it will heal in a way that it looks flat and faded. These topical treatments work best on immature or newly formed scars, which are less than three months.
Others prefer silicone sheets or tapes that provide constant pressure, thus preventing scar tissue formation or at least reducing its size and thickness. Their hydrating effects have also been found to encourage scars to heal and fade quickly.
Mature scars, meanwhile, are less responsive to scar massage and other treatments, although a good amount of improvement might be expected as long as they are treated with such vigorous approach; examples include steroid injections, lasers, and pressure therapy.
While not really a form of scar massage, some doctors recommend lymphatic drainage massage in which the primary goal is to control postop swelling, thereby accelerating one’s recovery. This involves gentle and “relaxing” kneading that is typically started two weeks after breast reduction surgery.
Many plastic surgeons can recommend trained massage therapists who will perform lymphatic drainage massage.