Dr. Ron Shapiro-Scar Revision w/ACell wound sheets & Vitrase-6 months

[Janna]

Here is a pic sent by our patient who had multiple strip surgeries in the early 2000's. He tried having the scar revised at a clinic near his home but felt it resulted in a bigger scar. He met with Dr. Ron to discuss how to approach the revision to produce the best result.

 

The scar revision was done in two steps - excised two sides in October of 2011 then the middle section scar was excised in March of 2012. He is well happy with the outcome of his scar revision. It's difficult to say just how much of the healing and the finer scar is courtesy of the of ACell wound strips/Vitrase or due to the technique itself.

 

Attached Image (viewed 2 times):

 

[Sean]

Wow, big difference. Great work!

[orlhair1]

This guy has to be thrilled. Nice!

[Janna]

Thanks Sean and Orlhairs. He is very happy with his scar revision and rightly so.

[chrisdav]

Scar looks much better now.

[RCWest]

Who originally did this man's surgery? I honestly have never in my life seen such a wide scar. Does Dr. Shapiro know the reason why he scarred so bad? You guys certainly did an amazing job on this scar revision! I know your patient is as thrilled as he can be.

[PupDaddy]

Wow, Janna! I can only imagine what emotional pain and daily hassle that scar had caused this fellow for the better part of a decade. This fellow's life had to have been transformed by Dr. Ron's efforts. Thank you for sharing this case.

[Blake Bloxham]

Nicely done!

[HARIRI]

Thats outstanding. Im planning to get a scar revision too. My scar is much better than this patient so I hope I get a similar result at least. Janna, what was his scar width before and what is his scar width right now?

[Janna]

I think he may not remember who did all his past surgeries but I will ask him. I'm quite sure he'll know the measurements of his scar before and after. We also have some of his before and photos too. This patient posted couple of times on another forum so I will copy and paste it here when I get a chance.

[Janna]

In response to ACell use at Shapiro Medical earlier this summer on another forum, I posted the following and used SPARTA AS AN EXAMPLE:

 

We have been offering ACell fine powder and wound strips for over a year. However, we do not use it on every patient. Before surgery, patients are made aware of the wound strips as an optional treatment. All feedback we've received from patients who have opted for the wound strips state they felt the healing was faster if nothing else. We have not heard that ACell makes the scar necessarily smaller for the scar revisions. For scar revisions or any post op patients giving feedback, it's difficult to attain good pics since their hairs have grown back. We have yet to hear that these patients feel their scars are worse off after their treatment with ACell wound strips.

 

There are several SMG patients who have been documenting their progress with ACell treatments. One in particular comes to mind is Sparta.

He has posted about his revisions with Shapiro Medical.

 

Below is what he wrote in his own post - I've copied and pasted belowso that you see first hand for yourself his experience with ACell and revisions.

 

I've labelled the photos accordingly to show different stages of the scar revision.

 

***********SPARTA WROTE NOV 15, 2011 ***************

 

Let me give you my opinion since I'm in a similar situation and just had a scar repair.

 

I had a bunch of other strip surgeries back in the mid 2000s that left me with a nasty scar from ear to ear due to the doctor not taking out high enough and another doc taking from the same area and making it worse. I also had a certain doc in NO VA try to repair it and he didn't do much to it (IMO he made it worse).

 

I just had surgery with Dr. Ron back in October just last month and we are doing a 2 part repair. Sides (from ear to back side on each side) in 1 surgery and the back middle in other. The scar is a tad smaller then yours but in parts is 1/2 wide and goes ear to ear.

 

Using this as an example (line being scar)

 

Ear <------------------------------------------------------------> Ear

 

First surgery I just did was taking out the scar from the sides (like below)...leaving just the back middle for the second repair.

 

Ear < Remove Remove ----------------------- Remove Remove > Ear

 

Dr. Ron and I both decided (and from my experience with ear to ear stitches), that it is better to take it out in 2 pieces because you aren't putting tension across the whole back and sides. I strongly suggest during a scar repair in 2 parts or even 3.

 

It's been a month now and I can tell you the following.

 

1. IMO, staples are the way to go. I just had my first staples ever with Dr. Ron and my lord I cannot believe at the 1 month mark how GOOD my scar looks. I know scars can widen later but right now, there is no widening, no redness, no nothing....but I think there is another reason for that...which is....

 

2. Dr. Ron used 2 things on me. #1 One was a substance called Vitrase which he used to help with the scar revision. Janna can explain it what it does but from my understanding it helps with making the repair less tight. #2 He also used ACell in the closure and I swear on my life, my scar at even 1 week looked like it was almost fully healed and more like a scar from 6 months out, not 1 week. After 1 month, all that is red is some of the staple holes and a minor faint redness in the super skinny scar line.

 

Dr Ron and I decided to leave the staples in longer also. We left all of them in for 14 days and took half out at the 14 day mark. Then we left them in for another 7 days and took the rest out on the 21st day. I think in scar repairs you have to leave them in longer. He said I could have taken them out at 14 but told me if I could deal with them for 21 days, then to keep them in. I think it made a big difference because I don't have ANY tightness and I feel the rest of the scalp stretched and not the scar during those 21 days. I can also tell you that I like staples better. I never itched at all with them and barely knew they were there after the 5th day.

 

I also feel that stitches cause shock loss and stretching from experience. Having the experience now of multiple stitch closures (tri and all) and now staples, I would NEVER go back to stitches. That's just my opinion.

 

Go see Dr. Ron and Im sure he can help you. Im going back in Feb/March to have my middle back part of the scar removed..and Im chomping at the bit because again, I cannot stress enough HOW GOOD of a job Dr. Ron did..and yes it's only 1 month, but I never felt or had a scar look this good at 1 month. I would also suggest thinking about the Vitrase and ACell...I'm literally floored at how well my scar is healed..and it has to be the ACell. I also ate really really well during the 2-3 weeks and ate lots of healthy foods and proteins and avoids most fatty and bad foods. I think that helped but again that is just my personal opinion on the food (but some say protein helps scars heal faster).

 

**********************************************************

 

Here are Sparta's before and after scar revision#1 and the 3rd pic is from his most recent scar revision #2

 

 

 

 

 

****************SPARTA WROTE AUGUST 16,2012******************

 

 

Hey everyone....

 

Wanted to give some feedback about the update Janna posted (that's me)

 

 

At 4 months...everything is looking great. I contribute this to various factors which I'll go over. I do believe the ACELL and Vitrase helped with this revision.

 

1. Vitrase: I got Vitrase (spelling) injected before the surgery. It loosens up the tissue and I can tell you for a fact that never after surgery or weeks later did my scalp feel tight. I think this goes a long way in really helping with scar repairs. I've had multiple surgeries before and every time the medicine wore off, the wound felt tight. Neither time has my scar/head felt tight after Vitrase.

 

2. Acell. I believe the Acell accelerated the healing process. Now mind you, some of the Acell stuff you are reading is about people sprinkling Acell into wounds. The Acell is really helping heal the deep tissue faster IMO and also the scar itself. It's not sprinkled..it's a thin sheet that is put under the scar then closed. It allows the deeper tissue to heal up faster and take some pressure off the outer skin (this is my opinion).

 

3. Staples. Let me say again. Staples staples staples. BAR NONE staples are the way to go. I was against getting staples and Dr. Ron convinced me to do them. The reason I got those bad scars IMO was because of sutures (and docs that took too much). Sutures just cannot do what staples do and the tension on the wound is MUCH greater due to the suture having to go around the whole scar. The staples on the other hand close the scar nicely and are actually smaller, leaving a smaller area of tension and are only on the outside...with the prongs 'pinching' the wound closed. These staples are like a quarter of an inch if that. Sutures lines go much taller...usually 3/16 at least.

 

4. Time. I know Janna cringes every time I tell her this (because of infection)...I firmly believe that a longer time with staples in is the way to go. In fact, I've told Janna straight up that IMO scar repair patients should have a minimum of 14 days for half the staples and 21 days for the rest. I actually went 21 days for taking half out and 28 days for the rest this time around. You're probably wondering how that didn't bother me or itch like hell nor get infected. Well I keep the wound super clean and honestly staples don't itch because they don't go all the way under the skin like sutures do. Most individuals get sutures out at 10 days...which is not enough time for the tension to subside in the healing process IMO. By leaving these staples in for 21 days and 28 days...the rest of my scalp adjusted/stretched and when they came out, I had no tension what-so-ever. I can't say the same about sutures coming out at 10 days. Every time I had that done, I felt the scar being tight and honestly feeling like it was stretching.

 

5. Activity. I didn't do ANY activity that moved my head much at all. No sit-ups, no weights that involved head movement, etc. Only ran and played softball this spring.

 

I'd say the final scar is less then 1/16 of an inch if that. You can only see it if you really hold up the hair and look...but running a comb through it you just cannot tell without looking really hard. Brushing it to the side and down...virtually undetectable.

 

Feel free to ask me any questions.

 

I'm going back up later in the year (NOV) for some FUE into the remaining tiny scar line, old punch holes and some into the crown/top. This will be my final repair surgery...YAY!

 

I owe a lot to Janna and Dr. Ron for really fixing this horrible scar I had..without them I'd still have a hideous scar...now it's virtually gone.

 

If you need a scar repair or any repair work (or even just normal work) go to Shapiro. Bar none the best in the business.

 

-Sparts

[GBU]

Great post , Janna . That guy had a scary scar . Good progress so far , it appears .