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This one is about: Various Comments on Lip Repair Scars


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VARIOUS COMMENTS ON LIP REPAIR SCARS by Joanne Green, Wide Smiles

Cleaning, Healing, Appearance after First Surgery, Revision

>Today is not a good day. This is day ten after his lip repair and as I was 
>applying the bacitracin ointment on his lip I noticed that what I thought 
>was a scab was only formula in a hole on one side of his repair (bilateral 
>lip repair, no columella). The hole goes from just under his nostril to 3/4 
>of the way down to his lip.

You're seeing now, what we try to avoid when we keep the suture line clean (parents are instructed, usually to use hydrogen peroxide solution and a Q-Tip to clean off all of the scabbing before applying ointment to a healing suture line - ask your doctor). If the scab is now off, and the edges are still fresh, there is a very good chance that the edges will continue to seal. If worst case scenario, it were to come apart again, it can be repaired a second time, this time with less stress on the suture line. The end result is likely to be similar to the result you originally hoped for.

When Joey's lip was repaired, in the hospital the nurse who cleaned the suture line left scabs on the lip. I had to stop her and teach her how to clean the stitches. I say that to illustrate that we need to be taught how 
to clean a suture line, and if we are not taught we have a tendency to leave scabs that can in turn, either become infections or fistulas. I think every new parent should be taught these techniques.

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>>One thing that our surgeon told us was that they will look great for the 
>>first couple of weeks and then the scar will begin to pull up. I don't 
>>know if this is the same for an adhesion also. But she was right. His lip 
>>looked great right after surgery and then a couple of weeks later it 
>>pulled up. Like someone pulling a thread in a seam and the seam bunches 
>>up. But it comes back down with time and the tightness lessons. 

>Exactly what happened with the scar on my daughters mouth. In a couple of 
>months it seemed pulled way up, but now, a couple of years later, it has 
>relaxed a bit more.

Yes, this does happen! Happily, it does not seem to happen with a revision, but it is common for a lip repair. It is part of the maturation process for the scar. A new scar will be tight and hard. An older scar will flatten and soften. While it is tight and hard, it bunches together. Because so much was done, and all the way through the tissue, the scar heals throughout the lip after the repair surgery. It does not have to heal throughout for revision work. Jacob's initially pulled up so much that people asked me if he was going to get his lip repaired! And yet, you should see him now! His lip is practically perfect!

If the lip looks notched at first, have patience. If it is still notched after about 9 months, maybe a revision will be needed. The drawing up is normal.

Joanne

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>I like to worry in advance, and I have often wondered how they do 
>remove/improve scars.  Also, they have said that they can improve the lip 
>on the left side where there isn't much vermillion (the pink lip tissue). 
>How do they do this?  There isn't any similar tissue on the body to borrow
>from?

The scar revision entails removing hard and wide scar tissue rejoining the freshened edges with many tiny stitches close together. These tiny black stitches are the ones that have to be removed by the doctor. The large number of tiny stitches ensure better scarring. The vermillion issue is a little different. What they tend to do is fill in the tissue behind the vermillion stretching and making better use of the vermillion that exists now. A graft of any kind is usually not expected. When we look at our kids now its hard to imagine how things can be rearranged and fixed, but it's no cliche, but it's amazing what they can do with plastic surgery.

-- Joanne


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