Scar Revision and Management After Neck Surgery

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For years, surgeons have told their patients that incisions on the skin of the neck will heal well, and probably won't even be noticeable. Recently, however, we have begun to learn that even the best healing can leave some patients self-conscious about their incision, no matter how well it heals.

One study from South Korea found that, regardless of how small an incision was, some patients were bothered by the fact that they had a neck incision (in this case, after a thyroidectomy). When doctors probed deeper, they found that it bothered some patients just as much as if they had vitiligo or psoriasis, both serious medical conditions that involve the skin and can be quite disfiguring.

In a study completed on patients from the United States, meanwhile, doctors found that only 50 percent of patients thought their thyroid scar looked “excellent” years after the surgery. Furthermore, more than 10 percent of patients were considering having their scar revised. The message was clear that at least some patients are self-conscious about their scar, and doctors and surgeons need to address these concerns.

What can patients and their doctors do when a scar proves bothersome?

First: Do no harm

The best way to make sure that your scar looks great is to avoid having a scar at all! While most patients who need thyroid or parathyroid surgery will have an incision across the front of their neck, new techniques are allowing others to avoid this completely. At high volume centers such as Johns Hopkins, there are surgeons who specialize in minimally invasive approaches. The newest of these, which is the only one without any skin incision, is the transoral thyroidectomy and parathyroidectomy approach. (As of this writing, most centers across the United States do not have experience with this technique.)

If having a scar is unavoidable, or if you already have a scar, the next thing to do is protect it. Especially during the first 6-12 months, your surgeon will stress the importance of keeping your scar out of the sun and away from repeat trauma that could impair its long-term appearance.

This earliest period is also the best time to intervene. For most patients, gentle lotions or gels (such as Vitamin E or cocoa butter) combined with massage will help to break up scar tissue and soften the incision. But do not start these techniques until you have spoken with your doctor. Doing these steps too soon after surgery may have the opposite effect.

If your doctor is noting redness or increased swelling at the incision line, he or she may recommend silicon strips or gel. These work to improve the appearance of hypertrophic scars and keloids when applied appropriately. They may help in your case, as well.

The final step to be considered during the earliest stages of wound healing is a steroid injection. Again, this will require discussing the risks and benefits with your doctor, but can effectively reduce prominent scars in some people.

Second: Start small

If you have done all of these things, usually your doctor will recommend waiting a period of time. Most often, surgeons and others often state that six months is a minimum amount of time to allow a scar to settle and mature (although others feel that the maturation process may take as long as two years). The steps above may be used during this time period.

On the other hand, some surgeons feel that laser treatment during this initial time period is most effective. Laser treatment is offered by many plastic surgeons and dermatologists, and can be very effective.

If more than six months has passed and you are still concerned about your scar, lasers will make up one of the primary methods that can be used to improve the scar. Talk to your doctor about the various options available. Similarly, other processes can be effective in some areas of the neck. Treatments such as chemical peels, which can be effective on the face, should be used with caution on the neck.

If all else fails…

If you have tried all of the above, it may be that the only thing left to do is start all over.

Sometimes, excising the scar (cutting it out) and re-closing the incision with a different type of suture or closure material may be more effective. Usually this will require at least some local anesthesia (numbing medication), but this can often be performed in the office of your surgeon or dermatologist. Because your doctor now knows just how problematic the scar has been, he or she may use variants of the initial technique or even inject steroids at the time of the re-excision. Perhaps additional steps can be taken in the subsequent recovery phase, as well.

Patients will usually ask if insurance will cover such procedures. While each provider is different, it is common for many insurance companies to cover at least part of the procedure. Before proceeding, however, make sure to speak with both your doctor and your insurance company to ensure that you don’t encounter a nasty surprise

The take-away

Much can be done for patients who are self-conscious about neck scars. While avoiding an incision at all is always ideal, the immediate post-operative period is the most important time to help things heal well. After that, there are many tools that can be used to help you recover fully. Talk to your surgeon or dermatologist for more information.

Sources:

Choi Y, Lee JH, Kim YHet al. Impact of postthyroidectomy scar on the quality of life of thyroid cancer patients. Ann Dermatol 2014; 26:693-699.

Best AR, Shipchandler TZ, Cordes SR. Midcervical scar satisfaction in thyroidectomy patients. Laryngoscope 2017; 127:1247-1252.

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