Thank you for your question. You submitted two photos of the area under your chin and
you stated that four months after your facelift surgery that you are undergoing treatment
laser specifically to help a pigmentation issues after your surgery. You stated also
that Kenalog was injected by your doctor during this timeframe. Well I think that as far as
you asking, “Are you doing the right thing,” I can give you some ideas of how I would handle
situation like this in my practice. My background is I’m a Board-certified cosmetic surgeon,
certified by the American Board of Cosmetic Surgery and a fellowship trained oculofacial
plastic surgeon. I am practiced in Manhattan in Long Island for over 20 years and facelifts
are a big part of my practice.
Just to get to the treatment plan we are to get to first what is likely to be the basis
for why you need this treatment. When you look at the first photo and you look at this
area, it is clear that at some point during your healing process that some type of collection
occurred under the chin. When we describe these collections in medicine we refer to
it into several different categories. One is hematoma or collection of blood after surgery,
another is called seroma which is similar to hematoma but it’s actually more of it’s
called a straw colored fluid that is related to inflammation and the leakage of fluid into
the space. Last is something called induration which is also based on a healing process that
where it can get kind of bumpy and irregular.
Now, all these treatments – all these situations require some kind of intervention and it seems
like everything is going in a way that I think most of my colleagues would agree where if
you recognize there are some type of scarring. That is a common pathway here is that with
some degree of chronicity meaning that after the first month or so, they’re maybe – there’s
normal healing and there’s normal resolution and then there is persistent inflammation
and we call it as organization of the tissue in a way that can form an undesirable scar.
When I say scar I’m talking about tissue that is between the area that’s operated
in the skin. Now, this intervention of using steroid like Kenalog is tentative care for
any of scarring situation.
For pigmentation the use of lasers definitely has its place and has value. Where I would
probably offer some alternative thought is that in my practice I have a lot of experience
with something called Platelet-Rich Plasma. Platelet-Rich Plasma is a topic or it’s
a method that first was developed by oral surgeons to facilitate the healing after a
– or dental implant surgery. It was then further developed in orthopedics for their
specialty to help with tendon and ligament and other types of tissue repair necessary
orthopedics. In our field is cosmetic surgery, it has yet to be fully embraced because of
not enough doctors get trained in it in their primary training nor is it very well understood
because of that limited exposure.
What I’m done in my practice is I developed my own process and systems of using PRP or
Platelet-Rich Plasma because we use it a lot. In fact, we use it as part of one of our other
areas of treatment which we do a lot of hair loss treatment called TrichoStem Hair Regeneration.
As far as scarring is concern, I’ve had a lot of success with the use of Platelet-Rich
Plasma for acne scars for thickened scars or hypertrophic scars for a lot of areas,
wrinkles of fine lines as well as under eye circles. But for scar tissue, we’ve done
combination of Platelet-Rich Plasma plus a cellular matrix, we’ve also done Platelet-Rich
Plasma alone. Now of course all this is being suggested and it may not be the right time
in your situation may be outside of the best window.
In clinical medicine, we do treatment and we observe response and I’m sure that’s
what your doctor’s been doing, so that’s why you’re on the path that you’re on.
I’m just offering this as a way to maybe not necessarily address scarring or pigmentation
for which Platelet-Rich Plasma does have value and has literally is risk-free because of
its – it’s almost risk-free in medicine. We never say risk-free because it’s your
own blood and it’s basically using your body’s own healing factors and in my hands,
I’ve had a lot of success with it in the treatment of scar tissue. I think that that’s
also value in terms of rehabilitation of soft tissue. Because Platelet-Rich Plasma has a
unique quality and that what it does is it stimulates blood supply, it stimulates new
collagen formation. It seems to have an effect on the collagen remodelling process.
If anyone questions they value Platelet-Rich Plasma all that to do is go on the PubMed
or the national library medicine index of articles written about Platelet-Rich Plasma.
There are hundreds and hundreds of articles demonstrating the benefits and the quality
of results using Platelet-Rich Plasma in a variety of instances. When I see patients
who have had previous surgery particularly for like eyelid retraction or complications
of facelift scarring et cetera, I find that they – even if I’m going to do – plan
to do sometime of surgical procedure, I’ll use Platelet-Rich Plasma as a way to rehabilitate
a tissue as I described before. Stimulating blood supply improving the vascularity and
the quality of the tissue is always a good thing. It allows for more successful surgical
revision plan.
When you think about when people use steroids or antimetabolites, there is still some collateral
tissue loss when used beyond the path of the scar. Even if it’s within the scar, you
can get adjacent skin and soft tissue atrophy. When you think about Platelet-Rich Plasma
this is some way to mitigate that. It can have some value. Again, without the benefit
of physical examination, it’s very difficult to offer one meaningful definitive recommendations.
Suddenly from my perspective your doctor is on the right track. You may want to have a
discussion with your doctor about Platelet-Rich Plasma as an option. I hope that was helpful.
I wish you the best of luck. Thank you for your question.