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Suggest Remedy For Tightness In Scar Tissues After Surgery

Posted on Tue, 23 Jun 2015

Question: Hi Doctors! I underwent surgery for adherent scar release under my lower lip and chin area about five weeks ago. ( In XXXXXXX 2012 I had a Chin implant put intraorally...which was taken out it Sept 2012 because of infection. Thereafter the adherent scar tissue under my lip was causing tightness...and... so I underwent this 'adherent scar release surgery' ) Now I have tightness in my chin area (apart from swelling issues) due to higher placement of sutures on the left side gingiva and also there's a cut on the inside of my lower lip - all this is causing problem in my speech esp. while speaking words containing letter 'F' (air blows out of my mouth)... I can't hold air inside my mouth with closed lips - the bottom lip has to pop out to do so...and also I can't whistle....I think it's all happening because of the weakness of some muscle as well as contraction/tightness due to higher placement of suture on the left side gingiva... what do you suggest for correction???

Answered by Dr. Sumit Bhatti (5 hours later)

Brief Answer:
Allow a few more weeks for healing.

Detailed Answer:
Hi,

Thank you for your query.

1. These are known complications of chin implant surgery and should be temporary. Internal healing takes 4-6 months and some 'absorbable' sutures take more than 6 months to dissolve.

2. An intra-oral incision for an implant will raise the periosteum (membrane covering all bones) off the mandible (jaw bone). The origin of the muscles of the mouth and lips is weakened as they are attached to this periosteum. This would settle down over a few months.

3. Another possibility is damage (including stretching) to the terminal motor nerves such as the marginal mandibular and buccal branches of the facial nerve (seventh cranial nerve). Check in the mirror if there is an asymmetry of the mouth when you smile. This will also be the cause for air leaking from the lips while speaking and inability to whistle. Steroids will help speed up recovery.

4. Numbness due to injury to the branches of the trigeminal (fifth cranial nerve) is also expected after such procedures and will affect your speech.

5. Fortunately, due to overlap of motor and sensory nerve supply, the recovery should be sooner than expected.

6. Every repeat procedure will cause more fibrosis. Allow time for the induration to settle. Physiotherapy, biofeedback, steroids (including local depot injections such as triamcinolone-Kenacort), hyaluronidase and local massage will decrease the recovery period.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (4 days later)

Hi Doctor!

Thanks for your detailed reply - I'm quite satisfied.
Well, now my PS is planning for revision of some sutures on the left side gingiva site in this week. Hopefully that would partially take care of some of my problems say - upward/inward movement of my left side lower lip, contraction in chin area, speech issue, pull/stretching while eating, etc. But... I'm not very sure about undergoing any procedure right now. I would like to wait for another month or so...so as to evaluate as to what has actually happened with my lips and chin...and then plan accordingly for the best reliable long term procedure with someone who is a super specialist in such type of procedures (Kindly do inform me if you now someone in North India). But...at the same time...I think I have to listen to my PS also....So, I'm in sort of a tricky and confused state right now.
Kindly offer some workable solution...
Doc, you asked me to check for any asymmetry when I smile...Though I don't find any asymmetry ...but I'm not 100% sure about it.
Kindly send me some email link so that I can send you my smiling pics (as there is no link in this Webpage where I can attach my pics).
Hoping to receive your invaluable suggestions once again ASAP.

Thanks.
XXXXXXX

Answered by Dr. Sumit Bhatti (10 hours later)

Brief Answer:
Wait few weeks. Specify your location. Upload the images.

Detailed Answer:
Hi,

Thank you for writing back.

1. You should wait for a few weeks before attempting any further procedure.

2. If you can specify your approximate location in XXXXXXX I will be able to guide you.

3. It is possible to upload images. Please E-mail YYYY@YYYY
or call +91-80 4190 3696.

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumit Bhatti (12 hours later)

Hi Doctor!
Yeah, as you have already suggested, I must wait for another month or so and then decide as to what procedure to do next and with whom... Well, I live in XXXXXXX (Jammu and Kashmir) and can travel up to XXXXXXX for my next procedure (if so needed) comfortably.
Attached are my pics (pre and post surgeries)for your evaluation.
Regards, XXXXXXX

Answered by Dr. Sumit Bhatti (8 hours later)

Brief Answer:
Yes, you should wait.

Detailed Answer:
Hi,

Thank you for writing back.

1. The images of the exterior seem to be fine. The symmetry is maintained. There are no images of the inside of the lip or while showing the teeth while smiling.

2. You should wait for some time.

3. If you do plan to go ahead at XXXXXXX I would advise you to check at the major hospitals such as Apollo, Medanta or XXXXXXX

I hope that I have answered your query. If you have any more questions I will be available to answer them.

Regards.

Note: Hope the answers resolves your concerns, however for further guidance of skin related queries consult our Dermatologist.Click here to book a consultation

Above answer was peer-reviewed by : Dr. Vinay Bhardwaj