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Atrophic Cheek Scar: Laser Peel + Profractional or HA Filler? (Photo)

On my right cheek I have a very small ice pick acne scar (which I may have excised) and a 5mm atrophic scar from a lesion removal that I HATE. Not a big deal to others but a HUGE deal to me. I've been to a few consultations and I think I'm down to Laser Peel + Profractional or HA filler. What would you do? My goal is to to flatten the scar to the point that make-up can camoflauge it. Is that even realistic? I'd rather not go through laser treatments if it's not going to help.

Doctor Answers (2)

Subcision & Fractional Medical Microneedle Have A Good Track Record For Raising & Blending Depressed Scars

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Unfortunately, to date I have not been impressed with laser success rates nor the actual degree of overall aesthetic improvement with their use. When it comes to lasers, there is an abundance of media hype and a dearth of rigorous scientific support.

Subcision is a procedure in which a sterilized needle is inserted, following the administration of local anesthesia, directly beneath a depressed scar (regardless of whether from acne, infection, trauma, or surgery) and used to break up the thick bands of fibrous scar tissue that bind down the surface and create the depression. 


Breaking up the abnormal bands of thickened, scar collagen accomplishes two things. First, it allows the surface of the scar to float to the surface. In addition, the tissue fluid that immediately fills the space following treatment contains growth factors and other wound healing substances that promote neocollagenesis, native collagen production, that allows for improvement and elevation of the scars. Between two to four treatments, spaced at six week intervals, are generally required to promote sufficient new collagen to achieve a satisfactory improvement. Since, the collagen produced is one's own, the results of subcision are typically permanent. A small amount of collagen-stimulating volumizer, such as Radiesse, may be instilled right after treatment to further promote neocollagenesis (new, native collagen formation).

Fractional microneedle therapy aka medical microneedling (or dermarolling) works by creating numerous areas of controlled microwounding that set off in turn a cascade of events that result in new, native collagen synthesis, which translates into healthier, thicker skin that improves the appearance of the underlying scars. It is particularly useful for improving the surface tone and texture of skin to enhance blending with the surrounding normal skin. In this case, it would be helpful for improving what appears to be a background of acne scarring.

I would be reluctant use CROSS therapy in this case, as the scar appears to broad and may actually become wider following such therapy. Scarabrasion, in which the scar is first removed (by punch excision) and then followed up by manually dermasanding the area about eight to twelve weeks later, is certainly a possibility. However, subcision is much simpler, requires no stitches or surface healing and would seem to me to be the treatment of first choice in this case.

Consultation with a board certified aesthetic core physician with extensive experience in all forms of scar treatment is essential.


New York Dermatologic Surgeon
5.0 out of 5 stars 13 reviews

Acne Scar Treatment

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We would gladly take care of you here and this type of scar is easily treated with Fraxel non-ablative or Fractional CO2 --- which I would prefer -- and then following with some subscision and filler.  I am one of the few who still uses silicone to treat these types of scars.  I would suggest going to a certified expert with a lot of experience in scar treatments, even if they are far.  I wish you the best of luck, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
5.0 out of 5 stars 46 reviews

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