How to Treat Indentations After Head Injury Sutures?

How can the indentation after suturing a head injury be restored?

Doctor, about a year ago, I suffered a skull fracture from falling down the stairs, which resulted in a stitched scar.
The scar feels like a sunken gap, and the surgeon mentioned that it was caused by the space between the bones.
At that time, I spent several thousand dollars on a method that would minimize scarring, but the indentation has remained unchanged for about a year.
I previously inquired about this, and the doctor advised me to wait for 2-3 months, but now that a year has passed, there has been no improvement.
What options do I have to restore the area to its original smooth and rounded appearance? Should I consult a plastic surgeon for this, or should I go back to the neurosurgeon who performed the surgery? The surgeon has been seeing me regularly for my anti-epileptic medication, and I have recently evaluated stopping the medication, so I won't be returning for follow-ups.
At the time of stopping the medication, I didn't think much about it, so I didn't ask him about the indentation.
However, I am still quite concerned about it and would like to seek your advice on how to address this issue and restore it to its original rounded shape.
Thank you.

Xiao Lu, 30~39 year old female. Ask Date: 2021/02/18

Dr. Ke Fangxu reply Surgery

If the depression left by a skull fracture is not visibly apparent to the naked eye, it is generally not treated.
However, if the individual is concerned about it, they can consult a neurosurgeon or a plastic surgeon to consider repair using artificial bone.

Reply Date: 2021/02/18

More Info

After a head injury, especially one that involves a skull fracture and subsequent sutures, it is not uncommon to experience changes in the appearance of the skin and underlying structures. The indentation you describe at the site of the suture may be due to several factors, including the healing process of the bone, the way the skin and soft tissues have healed, and possibly the presence of scar tissue.

When it comes to treating indentations or irregularities in the skin following a head injury, there are several options to consider. First and foremost, it is essential to consult with a qualified medical professional who specializes in this area. Given your situation, you may want to consider seeing a plastic surgeon or a dermatologist who specializes in scar revision. These specialists have the expertise to evaluate the indentation and recommend appropriate treatments.

1. Scar Revision Surgery: If the indentation is significant and bothersome, surgical options may be available. Scar revision surgery can help to improve the appearance of the scar by removing the scar tissue and re-closing the area in a way that minimizes future scarring. This procedure is typically performed under local anesthesia and can be very effective.

2. Dermal Fillers: For less severe indentations, dermal fillers can be used to plump up the area and create a smoother appearance. These fillers are typically temporary, lasting from several months to a couple of years, depending on the type used. This option may be suitable if you are looking for a less invasive approach.

3. Microneedling or Laser Therapy: These treatments can help improve the texture and appearance of the skin over time. Microneedling involves creating tiny punctures in the skin to stimulate collagen production, while laser therapy can target the scar tissue to promote healing and improve skin texture.

4. Topical Treatments: While these may not significantly change the indentation, using silicone gel sheets or topical silicone products can help flatten and soften scars over time. These are often recommended as a first-line treatment for scars.

5. Physical Therapy: If there are any functional issues related to the injury, such as muscle tightness or restricted movement in the neck or head, physical therapy may be beneficial. A physical therapist can provide exercises and treatments to help improve mobility and reduce discomfort.

Regarding your concern about whether to consult a plastic surgeon or the original neurosurgeon, it may be beneficial to start with the plastic surgeon, especially if your primary concern is cosmetic. However, if there are any lingering neurological symptoms or concerns about the underlying bone structure, it would be wise to consult with the neurosurgeon as well.

In conclusion, while it is understandable to be concerned about the appearance of the scar and the indentation, there are various treatment options available. It is crucial to have a thorough evaluation by a specialist who can provide personalized recommendations based on your specific situation. Remember that healing can take time, and patience is often necessary as you explore your options for improving the appearance of the scar.

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