Surgery best bet for left upper lip scar
I would proceed with surgery for the upper lip area scar. With local excision, and flaps, the area will look much better than what a laser can do. Afterwards, follow with resurfacing, my preference is the Fraxel re:pair. You don't have to do the entire face, just the cosmetic units which involve scars. You might consider V Beam just after the sutures are out to improve the appearance of the new surgically corrected area.
Non ablative 1540 Fractional Erbium Laser is Best for Facial Scars
I prefer non ablative fractional 1540 Erbium laser for treating facial scars. This laser WORKS when the person doing the treatment knows how to use the laser. Proper power settings are essential.
Laser treatments are non invasive and should be tried first. Surgical scar excisions especially around the mouth can cause worse scars and deformity.
The 1540 works. See link below.
Fraxel Restore does nothing
Fraxel restore is a non cutting laser and has been shown to do nothing for scars. Fraxel repair in the right hands at heavy or deeper setting can help scarring. This laser is a cutting or ablative laser and penetrates deeply enough to potentially help scars. Again, it depends on the setting used and the type of scarring. I find no laser helps "rolling" scars, which are the very wide scooped out scars that you notice with overhead lights. Scars similar to chicken pox scars can be helped with ablative lasers.
Again, it's not really the name brand of laser, it is the doctor performing it. Many lasers perform similarly to the Fraxel:repair and would produce similar results ie the Encore, the Quadralase. Of course, any traditional CO2 laser would also be useful which the two lasers above offer. Keep in mind that there is no treatment that will be 100% effective on scars.
Lasers are best used in the initial healing phase, before 8 weeks have passed, not now
While lasers can be extremely helpful (including the re:pair or traditional CO2 lasers) during the immediate period after having had a scar, at the time years afterwards they aren't all that helpful unfortunately.
What I see with my patients is absolutely incredible if we do CO2 laser within 8 weeks of the surgery, but if we wait too long, the results aren't all that good. For this reason, I would argue against laser treatment at this late date.
First, their is one inaccuracy in your statement. Fraxel Repair IS fractional ablative resurfacing.
For this severe, atrophic, hypopigmented and bound-down scarring of such long duration, you might want to consider surgical scar revision. A plastic surgeon would be best for this.
I do think that Deep FX, (also fractional ablative), which has differences from Repair that I believe make it a better alternative, would help. You would need several sessions, however, from your dermatologist and the settings would have to be aggressive.
I have used Fraxel Re:Store and Re:Pair extensively for facial rejuvenation and resurfacing as well as for various scars. I do not feel that the use of the Fraxel for your particular scars will result in enough improvement to justify the time and expense. See my prior answer to you about direct excision. The Fraxel may be beneficial along with fillers, after you have had the surgical approach and allowed full scar maturation (about 6 months). The Fraxel Re:Store, Re:Pair, and or fillers would be used to "fine tune" the results of the surgery if needed at all.