Indented lip scar

Hi, my almost 4 year old son was hit in the lip/face about 4 weeks ago with a hotwheel which caused a laceration to his upper lip which crossed the vermilion border.  It was about 1 cm long and according to the ER report was "subcutaneous". We requested a plastic surgeon to stitch it, but they refused saying it was not severe enough.  When all was said and done they only placed one 6-0 dissolvable suture in his lip below the vermilion border.  My husband was the one who had taken to the ER, and when they returned home, I was confused at to why they didn't place any additional sutures especially in the area above the lip, as the majority of the cut was outside the lip.  Apparently they said that part of the wound was not "deep enough" to require stitches. I personally thought they should have brought the edges together for a better cosmetic result and to create a thinner scar.  Now after four weeks, the wound has healed, but is slightly indented and still red.  My question is...is there any chance this indentation could still fill in, or is it likely to stay this way due to the way it was repaired?  Thanks!

[Howard Rosenberg, MD]

Its too early to evaluate the scar.  At four weeks collagen (scar tissue) is at its most disorganized for every wound.  As scar maturation occurs over the next four to six months, a better assesment of the resulting scar can be performed.  I suspect that significant improvement will occur and you might be suprised with the result.  The placement of additional sutures does not necessarily result in a better outcome.