I fell from a motorcycle in my country when I was little and have a scar on my face. I have always been very conscious when people stare at my left cheek when they talk to me. People also asked about it too. It doesn't really show on pictures but it a slightly deep scar. What is the best removal procedure for it?
What is the Best Scar Removal Method for my Childhood Face Scar?
Doctor Answers 3
Scars on the face are very bothersome to many people. Scars are can be noticeable because of any of these characteristics:
- Depressed relative to the surrounding skin
- Raised relative to the surrounding skin
- Discolored (lighter or darker than the surrounding skin)
- Not oriented within or parallel to skin wrinkles
- Cause a nearby structure to become misshapen (lip scars can cause a "snarl")
To determine what should be done, each scar needs to be looked at individually. Based on the photo, your scar appears slightly depressed and wide, but more or less the same color as the surrounding skin (incidently, this is likely because the injury occurred when you were young--healing is better then!).
There are many, many different ways to improve scars and the best results are obtained when multiple treatment modalities are used. In your case, I recommend dermabrasion (not microdermabrasion) followed by three Erbium:Glass laser scar treatments. With that regimen, I would expect you to have a dramatic improvement in your scar!
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Combining Subcision and Medical Microneedling Can Work Well for Scars
Unfortunately, the characteristics of the scar do not show up that well in the photograph. However, my impression is that the scar is slightly atrophic, i.e. sunken, and its surface color is off-white, with an overall somewhat irregular surface texture.
If this is indeed the case, a series of subcisions might help to raise the scar and bring it up flush with the surrounding skin. In subcision, the scar is numbed with local anesthesia and a sterile, sharp needle is inserted immediately below the scar and used to break up the tightly bound down fibrotic collagen that characterizes a scar. Doing so allows the surface to "float" upward and also stimulates, over the next few weeks, the production of new, more normal collagen to fill the void under the skin created by the movement of the needle. Between two and four treatments are often required, spaced at six week intervals, to obtain the desired improvement. Sometimes, simply raising the scar is pleasing enough.
If the surface of the scar is discolored or the texture irregular, medical microneedling can then be tried. In this procedure, a roller containing many fine needles is rolled over the surface of the scar, under local anesthesia, to create numerous microchannels in the skin. Here, too, fibrotic areas are broken up and new collagen formation stimulated, often with resultant improvement in both the surface texture and the color of the scar, helping it to blend much better with the surrounding normal skin. Once again, two to four treatments are often required to achieve this effect. Once achieved, the results of both subcision and medical microneedling are permanent..
Facial scar removal
From your photo, it looks like the scar is too large for a complete excision. It is possibe that the very deep scar you describe can be effectively removed with a small punch excision or punch floating technique. This can be combined with either fractional non-ablative or fractional ablative laser procedure such as Fraxel restore or repair. These lasers build up collagen in the skin layers of the scar. More aggressive treatment may include ablative laser such as erbium to smooth the edges of the scar.