LAM FACIAL PLASTICS

Dear Dr. Lam,

i'm a 47yr old female. three months ago, my dermatologist did a punch excision of a deep, 4mm boxcar scar right in the middle (apple) of my cheek...i think it was a bad decision:

1. the tension on the scar caused two distinct, flesh colored bumps -- one directly above and one directly below where the boxcar had been (perpendicular to the scar), and they haven't gone down at all. are they likely to get better, worse, or stay the same with time? is there anything that can be done to reduce/remove them?

2. leaving the stitches in for 7 days caused several icepick-type scars around the incision. also, on one on end of the excision, it didn't close quite properly, leaving a small, narrow, boxcar-type area. can either/both of these be helped with tca cross?

3. the area around the incision has widened and is very red (i'm using silicone sheeting). my dermatologist took one look and said to come back in 2 months for spot CO2. however, i don't hold out much hope for it helping much, based on what i've read in relation to the specifics of my scar that i've described. would having the entire scar re-excised (by someone more experienced, such as yourself) be an option? if so, would losing weight help to create loose skin to work with? (i'm 50 pounds overweight)

i'm sorry that the attached pic isn't very clear at all (also, the color is off -- as i am very light skinned), but hopefully, it will give you an idea of the situation. i'd greatly appreciate any insight you can offer.

this is why i don't do punches because i believe they don't work consistently well and carry risk. cutting it out more would possibly just make things worse. i would consider light IPL or KTP laser to help with modulating the scar and the redness. silicone gel/sheet is a good idea, as you are doing. losing weight will not help. patience is probably the best course of action. don't know if co2 would help or hurt. to me it does not sound good to put on a red angry scar but you need to see your doctor in person to help you decide that.
best,
sml