hypertrophic scars, keloids, and various other wound healing abnormalities.9 The combination of 5-FU and triamcinolone injectionshave been shown to be safe and effective with very little side effect profile.7,9,13-15 Laser resurfacing, dermabrasion, or surgical revision are other options, but they are less common and are usually performed in the post-acute healing phase ifthe above mentioned options do not provide improvement.16,17Glucocorticoid suspension injection remains a first-line treatment; however, this treatment has substantial side effects whenglucocorticoid is applied alone, which limits its clinical utility. Because 5-FU inhibits cell proliferation, the combination of 5-FU with triamcinolone produces good results, and this combination has been used for clinical treatment.Silicone cream has been shown to improve the appearance of postoperative scars in various studies.18-20 Silicone cream’sgenerally accepted mechanism of action is twofold: wound hydration and occlusion during the maturation phase of woundhealing.18-20 We believe that the use of a silicone-based topical scar cream may reduce the incidence of postoperative cicatricialand hypertrophic changes in post blepharoplasty incisions, and as a result, reduce the incidence of postoperative intralesionalwound modulation. We are not aware of any study that evaluates the use of a topical scar cream and the incidence of postoperative cicatricial and hypertrophic changes requiring intralesional wound modulation post blepharoplasty.In our study, we utilized SKN2017B, a recently developed silicone-based scar cream, as our post blepharoplasty scar cream. SKN2017B has been shown to be safe and effective for cutaneous scars in areas such as the eyelids, breasts, and abdomen. In addition to silicone cream, SKN2017B also contains synthetic recombinant human transforming growth factor beta-3 (TGF-β3), hyaluronic acid (HA), and Vitamin C as key ingredients. Both TGF-β3 and HA are implicated in fetal scarless healing.18,21 The cream also contains several other synthetic recombinant human growth factors, Aloe vera extract, and Centella asiatica extract, all of which have been individually shown to positively influence wound healing and/or scarring.22-25 A large, randomized, multicenter, double-blinded clinical trial comparing SKN2017B to silicone cream showed that SKN2017B demonstrated a 73% improvement in the appearance of scars on the eyelids, face, breasts, and abdomen when compared to silicone cream.26This current study compares the incidence of post upper eyelid blepharoplasty cicatricial and hypertrophic scarring in subjectsthat used a topical silicone-based cream beginning 2 weeks post procedure to those that did not receive topical scar therapy(no treatment).
METHODS
This is a retrospective, single-surgeon case series study of patients that underwent a cosmetic upper eyelid blepharoplasty between January 2015 and December 2017. During this time period, postoperative upper blepharoplasty incisions were either treated with a silicone-based topical scar cream (SKN2017B) twice daily for 3 months or received no treatment. SKN2017B was clinically developed for patient use by November 2016, and patients that received blepharoplasty surgery after November 2016 were instructed to use SKN2017B on their eyelid incisions. The study was approved by an institutional review board (Solutions IRB, Little Rock, AZ). The study was conducted in accordance with the provisions of the Declaration of Helsinki and was in compliance with the Health Portability and Accountability Act. SKN2017B is manufactured by MD Medical Designs, Los Angeles, CA.Patients were excluded from the study if they underwent a concomitant ptosis repair, eyelid surgery that required supratarsal fixation, or prior upper eyelid surgery. Those that had a combined endoscopic brow lift and/or lower eyelid blepharoplasty were included in the study. For both groups, a chart review spanning January 2015 to December 2017 was performed, and the incidence of combined intralesional injections of triamcinolone and 5-FU for cicatricial and hypertrophic areas along the upper eyelid incisions within the first 6 months post blepharoplasty was recorded. A T-test was performed for statistical analysis.All patients underwent an upper eyelid blepharoplasty by the senior author (C.I.Z.), a right-handed surgeon. Excess skin was marked for removal prior to surgery and removed using a 15 blade to incise the skin, followed by removal of the skin flap using Westcott scissors, sparing the underlying orbicularis muscle. Prolapsed medial fat was debulked in those cases that had prominent nasal fat pads using monopolar cautery. Gentle cautery was applied for hemostasis using a monopolar cautery. At the end of the case, the wounds were closed with a running suture in addition to approximately four interrupted sutures along the wound using a 6-0 polypropylene suture, one located medially, two centrally, and one laterally. All patients were instructed to use erythromycin ophthalmic ointment for seven days postoperatively. Sutures were removed on either postoperative day six or seven, and patients were next seen at their routine postoperative visits at: postoperative month 1, month 3, and an optional month 6 depending on their healing. Patients that were instructed to use SKN2017B began to apply the cream to their upper eyelid incisions at postoperative week 2, twice daily, for 3 months. Patients within the SKN2017B group had been using the cream topically for 2 weeks at their week 4 postoperative visit. Patients were first evaluated for cicatricial
