A 48-YEAR-OLD WOMAN was seen in consultation for evaluation of the aging face. She had had significant sun exposure in the past and noted generalized facial laxity. A deep-plane facelift was performed, along with simultaneous perioral dermabrasion. The dermabrasion was done with a diamond fraise burr to the level of punctate bleeding, indicating a surgical depth in the papillary dermis.
The upper lip was epithelialized within 2 weeks of surgery. When seen 3 weeks after surgery, the patient complained of itching of the upper lip with some erythema and induration, greater on the right than left (Figure 1). Palpation of the area revealed some mild induration, and she was started on topical silicone gel treatment. Three weeks later, the patient was seen again and noted that the silicone gel produced skin irritation, and she was started on topical corticosteroid cream treatment. She continued to complain of itching, and she had excoriation of the area when seen the next week. At that time, steroid was injected into the lesion in the right upper lip. She was then seen 6 weeks later, and the scar on the right upper lip had not improved (Figure 2). The patient was now developing increasing erythema and induration of the central left upper lip as well. Topical flurandrenolide tape was applied without benefit after 2 weeks. She then underwent a trial of oral prednisone starting at 30 mg/d, tapering use during a 4-week period. This was immediately followed by pulsed-dye laser treatment to the area of scarring. She then underwent 3 more sessions of pulsed-dye laser treatment, with an interval between treatments of 6 weeks. Midway between the dye-laser treatments, the scars were injected with fluorinated corticosteroid and progressively during the next 6 months the erythema and induration of the scars gradually improved (Figure 3).