Would subcision alone minimize the appearance of a scar on my nasal bridge or should I consider adding filler as well? (photo)

Question

I’m trying to decide if I should try subcision alone, or subcision with filler. I tried filler in scar and made it way worse. Filler migrated out of scar, and surrounded scar like a picture frame. Filler is now gone… after 6 months. Should I try subcision for the atrophy? Is this dangerous on nasal bridge. Should I try with or without filler? Or any other suggestions. Your help so deeply appreciated. Also my scar is turning white (it’s from a laser burn- trying to treat a red spider vein)

Nelson Lee Novick, MD · Answer

I'm sorry you have this problem. As my regular followers well know, I have been cautioning them for years to exercise a great deal of "buyer beware" when being hawked expensive, laser, RF or other so-called light and energy-based devices owing to their unproven or variable results and their risks, such as scarring and permanent hypopigmentation, as in this case. Sorry.
From the photo provided, in the hands of an experienced, board certified cosmetic dermatologist scar treatment and filler expert, subcision accompanied by the use an appropriate HA filler would be a very reasonable approach for elevating and smoothing the scar. As this appears to have precipitous, broad "shoulders,," this may also require light cautery treatment or the use of an appropriate peeling agent to create a more rolling border. Once the scar base is elevated appropriately, the hypopigmentation can be addressed with by professionally performed, manual Dermastamp microneedling (no need for the added risks and expense of RF microneedling) accompanied by the topical application of Rx pigment enhancers. Hope this helps and best of luck. 
Make sure to consult with a board certified

Anna Chacon, MD, FAAD · Answer

Thank you for your detailed question. Based on your experience, it sounds like the filler may have contributed to unwanted contour irregularities due to migration, which is not uncommon in areas with thin skin like the nasal bridge.

Subcision alone can help release the tethering underneath atrophic scars and may improve contour by allowing natural collagen remodeling. On the nasal bridge, subcision must be performed with precision, as the area has limited soft tissue and is close to important vascular structures. That said, in expert hands, it can be done safely.

Given your past issue with filler migration, starting with subcision alone may be a more cautious and reasonable approach. If the improvement is insufficient, a small amount of filler can be reconsidered later — ideally with a firmer, more cohesive filler, and injected more deeply and conservatively to avoid superficial migration.

As for the scar turning white, this may be a form of hypopigmentation or post-inflammatory color change, which is sometimes seen after laser burns. Unfortunately, this can be more resistant to treatment, but modalities like microneedling with PRP, low-energy fractional lasers, or even topical agents may help gradually blend the area.

Ultimately, go slowly and favor the least invasive option first.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Would subcision alone minimize the appearance of a scar on my nasal bridge or should I consider adding filler as well? (photo)

Answers (3)

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