LAM FACIAL PLASTICS

Hi Dr Lam
My son received a laceration to his nose (vertical line from tip almost to bridge) at birth as a result of a forceps delivery. At the time we were told that we would need to wait at least 2 years before any scar revision was considered.
It has now been 10 months. The 2 year wait is most certainly fine with me (as, of course, it does not bother my son at this point in time).
It has healed, so far (10 months) to a white line that is broader at the top-end (nose bridge end) and barely detectable at the bottom (nose tip). It is as though it is healing like a zip closing (from the nose tip upwards).
My questions are these:
1. Do children/babies have a longer scar maturation period than adults? (Hence the advice to wait 2 years rather than the more typical 6 months – 1 year) (ie. Is it likely his scar will continue to change/shrink/narrow for up to 2 years or more?)
2. Once a scar has turned white, is it mature? Or can it still change? (my son’s scar is still slightly indented (like a valley) but has become MUCH less indented than it was originally and looks (to me) to still be changing, but it is lighter than the surrounding skin).
3. As he grows, do you think it is likely the scar will blend somewhat with his natural skin tone?
4. Does the nose typically respond well to surgical scar revision?
5. Could non-invasive procedures possibly help in the future?
I know every case is individual but I would greatly appreciate any response you could provide.
Ultimately, I guess I am just seeking to manage my expectations around his likely healing over the next year or so. It would also bring peace of mind to know that something could be done if it was ever required. Thank you, I appreciate your time and love your holistic approach to healing.

well, if it is not truly noticeable except a white line, then it might not be worth a scar revision in someone that young for a # of reasons (but again i cannot offer you specific advice in this forum). here are the big reasons:

a cut on a child leads to a very bad scar typically, 10 to 20 x worse than an adult and 100x worse than a grandparent. children tend to respond very aggressively to scars and create too much scar tissue. their skin is perfect so anything shows up. there is no laxity for a closure to be undertaken. if a scar revision is undertaken therefore the result could be 50x worse than what your child has now.

plus:

on the nose, the skin tends to be inelastic requiring undermining to perform which is not a great idea in someone that young plus it could result in nasal changes in growth or lack thereof by compromising blood flow in the dissected areas. the nose tissue is particularly unique.

however, in children if there is something very wrong or visible with the scar, then we have to take into account psychological issues. i did a paper on that and children by the age of 2 start to identify self from non-self and that can lead to social impairment so the scar repair has to be weighed against that factor.

a white scar is mature btw. if it is thicker, then injectable 5-FU or laser may be good but again it must be weighed against the benefit and the trauma on a small baby child. i think what you are describing most likely will blend in over time but i would speak with a physician to be more certain. a scar revision on the nose should truly be undertaken only by someone who understands the nose. a plastic surgeon who only occasionally dabbles on the nose is not a good candidate to eventually work on that nose because it is a more complicated repair, i.e., maybe when your child grows up and decides to have it done. hopefully those ideas were helpful broad strokes.
best,
sml

Thank you, I appreciate your honest response.
Because scar revision for my son may be 10 years + away, are there any emerging procedures that are looking at all promising for re-pigmenting white scars in the future?
Thanks.

yes, PUVA therapy but i think there is long-term risk in children with it but i am not here to state that affirmatively. you need to ask a dermatologist about pulsed UV therapy. if it were my child and it was a narrow line, i would not do it.
best,
sml

Yes, sounds like a case of leaving well enough alone at this stage.
Thank you for your insights. Most appreciated.

you're welcome!