In trying to treat acne scarring, I was left with the scar you see in the photos after dermabrasion. I'm wondering what can be done to improve it, and what order I should do it in? For example, I'd like to improve the redness but see no point in improving the redness only to have an ablative laser over the area which would redden it for months. I'm open to multiple steps. Unfortunate placement under my cheekbone makes it even more noticeable, I think. What could work? What would be a waste? Thanks
Scar Revision for Atrophic Scar: Where to Start? (photo)
Doctor Answers 3
Atrophic Scars Respond Well To A Combination of Subcision, Medical Microneedling & The Punctuated Phenol Peel Work
Before excising, I would suggest a series of subcision treatments. Subcision is a simple procedure that uses a needle-like cutting device that is slipped under the scar (under local anesthetic) and moved from side to side in order to break up the fibrous bands of scar tissue. This allows for the surface of the scar to float to the surface and also to promote new, more normal collagen synthesis to fill the potential space created. The result--a much more shallow scar and often significant visual improvement. A decided benefit to this approach is that the results are permanent, since the technique, as was pointed out, is predicated upon the person's own ability to produce new collagen in response to treatment.
When there is an unsightly surface texture to the scar, a series of medical microneedling treatments can be initiated. For relatively small scars, the DermaStamp can be used. This is a small instrument with a series of sterilized needles attached, which may be used, under local anesthesia, to disrupt the surface of the scar, allowing it to reform in a more uniform texture and sometimes color.
Alternatively, the Punctuated Phenol Peel technique may be used. With this technique, also performed as a series of treatments, microdroplets of full strength phenol are placed along the scar--leaving intervening untreated spaces (a fractionated approach) from which healing may take more rapidly and with less risk for actually causing a scar.
Most often, I have found that subcision performed alone or combined with medical microneedling is capable of producing quite a gratifying aesthetic improvement.
Finally, some immediate overall improvement and smoothing of the scar might be achieved with the use of a volumizing filler, such as Radiesse or Radiesse combined with Voluma (not yet available in the U.S., although soon to be) injected immediately under the scar to diminish some of that sunken appearance.
Scar Revision for Atrophic Scar: Where to Start?
I agree with Dr. Echavez in that you will likely see improvement in the color and texture over the first 12 months following the dermabrasion. I doubt that this will be satisfactory though. Serial excision would likely be very effective to totally excise this scar while creating the shortest possible resulting surgical scar. This would essentially result in removing the entire area with 2-3 procedures performed over time. A single excision of this area would require a surgical incision 2 1/2 - 3 times the length of the scar being removed. Serial excision would significantly reduce this. I hope this information is helpful.
Stephen Weber MD, FACS
Weber Facial Plastic Surgery
Treatment options for atrophic scar on cheek
How long ago was your dermabrasion done? It's possible that you would still get some improvement in the color if it's only been a few months since the procedure. It is possible to use a laser to improve the redness, but this would not improve the depression in the tissue. While it is possible to use injectable fillers to help with the depression, I would consider a surgical scar revision on the scar to just remove it completely and give you a less noticeable scar.