Hello Dr Naderi
I just read an old blog of yours on makemeheal.com about dermal grafting for acne scars. At that time you said you do perform both dermal grafting and punch grafting. You went on to say if the epidermal character is so poor that mere filling is not adequate and that the whole skin thickness may need to be replaced. If the scar is large enough it should be excised, if it is small enough if should be punched.
My question is how does one determine if filling would not be adequate? I have two very large deep rolling type scars that I had injected three times in the past (with restylane) with different dr’s each time – and the filler simply donuted around the scar. Would that mean most likely dermal grafting would not work for me as well? I was initially considering surgical excission however two plastic surgeons told me from their experience these types of scars tend to depress again after excision. Those statements are what has me investigating some other (non injectable way) to fill the depressions – either with a synthetic graft or dermal graft.
Answer:
Hi Kristin,
I just read an old blog of yours on makemeheal.com about dermal grafting for acne scars. At that time you said you do perform both dermal grafting and punch grafting. You went on to say if the epidermal character is so poor that mere filling is not adequate and that the whole skin thickness may need to be replaced. If the scar is large enough it should be excised, if it is small enough if should be punched.
That is correct. I did say that. When you say the filler “donuted around the scar” it means that the scar is tethered down and there is simply no potential space for it to be filled. There are options in such cases. Your doctor can use the Restylane needle or a larger needle to release some of the deep scar bands. Subcision is a more aggressive form of this. This will create a space for filler or fat to sit and lift the skin up. Alternatively, the scar and the overlying skin can be excised. With proper closure technique, it should not get depressed again. It requires multi layer closure with proper skin edge eversion. Sometimes, an additional deep fascia or dermal or even Alloderm graft is needed underneath the skin. This is usually followed by Dermabrasion 6 weeks later IF YOUR SKIN COLOR allows that type of resurfacing.
Unfortunately without seeing and examining you, I cannot be more specific about your individual skin and the best treatment for you. But these are some ideas for your research.
