Spot dermabrasion of nasal scars using sterilized sandpaper is certainly an option, especially for shallower scars and is a safe procedure with a proven track record over many decades. However, I am skeptical about the extent of improvement in deeper scars, as seems to be the case here. I have personally achieved consistent and gratifying results using a combination of subcision, fractional microneedling therapy (medical microneedling) and, when deemed appropriate, the additional injection of a collagen stimulatory filler for improving depressed, atrophic acne scars, which appears to be the case here.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. Finally, the area under the scar can be volumized and smoothed, prior to treatment, by the injection, in a fanlike fashion, of a volumizing agent with a high lifting force. This not only gives immediate improvement by stretching and making more superficial the overlying atrophic scars, but also makes the fractional microneedle therapy, easier to perform. Here I prefer to use Radiesse or Radiesse combined with Voluma injected immediately under the scar to diminish more of that sunken appearance.Clearly consultation with a board certified aesthetic physician with extensive experience with all these treatment modalities is warranted.