I ended up canceling Fraxel for my atrophic surgical scar because I was not convinced it was the best treatment for me. The anecdotal evidence of the efficacy and long-term results of Fraxel are very mixed (RealSelf lists a satisfaction rate of only 52%!) and many of the clinical studies were funded by the manufacturer, so I question the objectivity. The scar is on my forehead is about 2 inches long, perpendicular to the RSTL, thin, red, and slightly atrophic. My plastic surgeon did a scar revision surgery. He used Botox after the revision to immobilize the scar, and we have decided on a few sessions of subcision to stimulate collagen growth under the scar, followed by a resurfacing procedure which will be done elsewhere. It will either be Laser or rotary wheel Dermabrasion. Which between the two is best for my scar? If Laser, which type?
Dermabrasion Vs. Laser Treatment for Atrophic Scars
Doctor Answers 5
Dermabrasion versus Laser for Scar
If it is a relatively fresh surgical scar, dermabrasion at about the 6 week point has been found to help, however a two inch vertical forehead scar may need a z plasty to reposition prior to resurfacing for optimal result.
Dermabrasion versus laser for scar revision
Dermabrasion is a very effective technique to resurface the skin and to correct some prominent scars. Dermabrasion works by sending down the outer layers of skin until the deeper layers are exposed. It is these deeper layers of skin that will regrow skin and hopefully improved quality. Lasers perform basically the same function. When choosing between treatments, consider the amount of area that need to be treated and the depth of skin that he can be reached. Lasers often work better if the entire face needs to be resurfaced. If you have a small area of skin or a discrete scar, either procedure may work effectively.
Options for scar revision
There are some studies to suggest that dermabrasion 6-8 weeks after surgical correction may provide enahncements in the ultimate appearance of the scar. This may be an option you want to consider.
Skin needling is another option for stimulating collagen formation.
Use of fillers, temporary or permanent, may be another alternative to consider.
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Laser or dermabrasion or re-scar revision may all work
A significant part of my practice is nasal reconstruction were I take a stip of skin from the forehead to rebuild the nose. As a result I deal with a large number of forehead incisions. Scars in this area are rare if the forehead is closed correctly. It is possible that the scar revision you had was not as good as it could have been. When it comes to scars I prefer dermabrasion over the fractionated CO2 laser (I have the DeepFX laser). That being said the only scars I will dermabrade are if the scar it self is raised up above the height of the surrounding skin. If it is lower than the skin or depressed you end up sanding away a lot of good skin to get it even and that typically doesnt look that good. Without seeing your photos it is hard to know what is best for you. So you may actually benefit from a scar revision depending on how your scar looks now.
I hope this helps...
Dermabrasion vs. subcision vs. fractional co2 laser for resurfacing of scars on the face
In my plastic surgery practice, I prefer the fractional co2 laser as the depth of penetration is more well controlled. The dermabrasion technique is less refined and may induce secondary hyperpigmentation at a higher rate.