Multiple raised hypertrophic nose scar lesions? Are ablative lasers (CO2/Erbium) my only option? East Asian skin type (Photo)

Question

I have had these scars since 2014, which came from severe cystic acne. I no longer get acne on my nose so I want to get rid of the scars. What would be the best option for this? How many treatments? Do I need to combine ablative laser with something else? From my research only ablative lasers can improve these annoying lesions. Given your experience, how much of an improvement after ablative (% wise) can I achieve? I'm asian. Also, what is my skin type? I'm guessing Fitzpatrick III or IV?

Jason Emer, MD · Answer

this needs ablative laser or needle dessication takes a few treatments and often leaves pigmentation if you do not do enlighte or cosmealn peels before and creams below (see below and link) after. you should also do halo or fraxel on top to "blend."
See emeragecosmetics.com where we do free skincare consults daily. Scars need aerify, enlighten, or Cosmelan peels post surgery. Vivaria forma, Restorsea 10x, skinceuticals phyto +, Cosmelan 2 cream, and reven skin fortified bleaching cream all help. You will need a combination of lasers in most instances and/or Microneedling.
no medical insurance covers keloid removal. you have a chance of recurrence with surgical removal but lasers can help reduce the look.
there are many options for hypertrophic/red/discolored scars:
1. vascular lasers (yellow laser, vbeam, excel v)
2. fractional lasers (fraxel, erbium, co2)
3. microneedling/PRP
4. silicone based scar gels with growth factors
5. excision +/- radiation
see an expert.
Best, Dr. Emer.

Shobhan Manoharan, MBBS, FACD · Answer

For scars and changes like this on the nose, which we do often see with Asian skin types and skin of colour, I agree ablative laser is the most likely to produce results.

However I tend to combine it with intralesional steroid and 5FU delivered during the laser treatment and often with 1 to 2 sessions at least 75% improvement can be made.

Skin type is likely Fitz III.

Good luck
Dr Manoharan

Davin Lim, MBBS, FACD - Account Suspended · Answer

These are more than likely papular hypertrophic scars. Resurfacing is a high gain procedure, however the side effect could be rebound scarring. I usually test spot an area first. A safer approach is RFM - low energy or microneedling- fractional WITH ILCS steroid drip. 2-4 sessions.

The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery.

Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits.

Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening.

The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types.

My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis.

All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.

Multiple raised hypertrophic nose scar lesions? Are ablative lasers (CO2/Erbium) my only option? East Asian skin type (Photo)

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Multiple raised hypertrophic nose scar lesions? Are ablative lasers (CO2/Erbium) my only option? East Asian skin type (Photo)

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Everything you need to know about CO2 Laser

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