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Plastic Surgery/Midline dermoid Cyst Scar on infant


My son\'s scar
My son's scar  
Hi, My son had his midline dermoid cyst removed at 6 months. We saw several doctors and the fear was that because it was midline there might be a thread going through the skull. I saw a peds neurosurgeon who said he was certain that it wasn't in the bone, and that he wouldn't have a MRI done, but if I went through with one of the doctors at his hospital he would be present for the procedure in case any problems arose. At any rate, the Plastic surgeons at NY Presbyterian either weren't taking new patients or didn't take insurance. So the first name the neurosurgeon recommended was an ENT. I asked the questions well what twas the difference between an ENT and plastic surgeon, and they said not to focus on title but experience. The ENT also said that he's a certified Plastic surgeon and that there would be no difference. I went through the surgery with the ENT.
After Surgery, we found out there was no thread (great!) but then I was concerned about the scar. The recovery nurse said that now a days they do the stitches on the inside and that there would be no "rail road track marks". When the strips came off, I noticed this was not the case. At our post op apt, the doctor seemed very happy with the results, and when I asked about the stitching method he just answered yes sometimes we use that method, but we didn't here.

So now it is 3 Months after surgery, and the stitch marks are the worst part of the scar. They make the whole scar look much larger. Since they are vertical I'm assuming that they will stretch farther too.

At this point I'm wondering what you think of the scar, will the vertical stitch marks fade, or will they scar as well? Is he a good candidate for scar revision when the scar is all healed. Also are there any things that I can do now to help reduce the scar? I'm looking for any insight that you can share. Thanks

from Dr. Alan Engler

Hi Jessica,

I wish that I could wave the magic wand and make it so that your son (1) didn't have this in the first place and/or (2) the result were more in line with what we would all want (ie, no evidence that the surgery was done).  

It is very difficult to predict what any scar will look like and it takes a long time - up to two years or sometimes even longer - to see what that result will be.  And that's in adults.  In kids (who are growing) it can take even longer than that, since the scar is stretched a bit as the child grows (though the head is more fully grown early on than the rest of the body) but, at the same time, skin relaxes a bit as the rate of growing slows.  As a result, we/I don't do scar revisions on children unless they are clearly impairing function (ie, a scar across a crease that prevents an arm from moving correctly).  That applies to the entire scar, including the stitch marks.

I usually advise that putting a little mild ointment (such as Aquaphor) is about all that should be done, but since it's so close to the eyes I wouldn't even do that in this case.  Sunscreen and protection from the sun is important for the skin in general, and even more so for scars.

And then you really have to just monitor it.  If it becomes more noticeable rather than less you can always reconsider some sort of intervention.  If it is raised, a steroid injection might help flatten it but, again, I would hesitate to do that on such a young child.

You may want to contact a pediatric plastic surgeon for oversight.  I can recommend David Staffenberg, MD at NYU, whom I know personally and who is the Chairman of Pediatric Plastic Surgery there.

I hope that this helps and good luck,

Dr. Alan Engler

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Alan M. Engler, MD, FACS


Dr. Engler has answered over 6400 questions on social media sites, including over 3500 on AllExperts alone. His expertise includes breast surgery (breast enlargement with implants, breast reduction, breast lifts), liposuction, eyelid surgery, tummy tucks, facelifts, lipomas, skin cancers, cysts, etc. Dr. Engler has been listed as one New York`s Top Doctors, and as "One of the World's Most Famous Aesthetic Surgeons" (Aesthetic Surgery, TASCHEN Books, Angelika Taschen, Editor). He is the author of 4 books, including "BodySculpture" (a best-selling plastic surgery book on breast surgery, liposuction and tummy tucks), "EyeScapes" (Plastic Surgery of the Eyelids), "Restylane," and "The Slim Book of Liposuction." Dr. Engler has two US Patents for surgical instruments that he's designed, and has appeared on numerous television shows, including The Tyra Banks Show, The Ricki Lake Show (four times), the Dr. Keith Ablow Show and Jerseylicious. Videos of his appearances are available on YouTube (search for "DR. ENGLER"), and his discussion of breast implants, also on YouTube is "How to Choose a Breast Implant." His website is Follow Dr. Engler: @AlanEnglerMD


Dr. Alan Engler is a board-certified plastic surgeon in New York and the author of BodySculpture - Plastic Surgery of the Body for Men and Women (ISBN 0966382749) one of the top-selling plastic surgery books on,, as well as EyeScapes - Plastic Surgery of the Eyelids.

Dr. Engler graduated from Yale University (BA, Russian Studies) and the Columbia University College of Physicians and Surgeons (MD). He did his residency training in General Surgery and, after that, Plastic Surgery, at the Montefiore Medical Center in New York. He is on the faculty of the Albert Einstein College of Medicine in New York in the Departments of both Surgery (Plastic Surgery) and Medicine (Dermatology), and is a Special Lecturer in the Department of Dermatology at Columbia University in New York. He has admitting privileges at Beth Israel Medical Center and Montefiore Medical Center, both in New York.

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