What are the best treatment options for my nose scar? (Photos)

Question

I experienced a nose injury on January 16th of 2026 (4 months ago), resulting in 2 raised/hypertrophic scar areas. One scar area is a circular mound of tissue, while the other includes multiple uneven incision lines. I have consulted with both a plastic surgeon and a cosmetic dermatologist regarding the best treatment for these, but have been given conflicting advice. One provider has advised to have Kenalog and standard Microneedling with an emphasis on avoiding RF Microneedling. The other provider has recommended a few V-Beam laser treatments, followed by RF Microneedling, and potentially Fractional CO2 laser. I'm willing to do whatever it takes and travel as far as necessary to obtain the best possible outcome for these scars, but I'm confused as to what the best treatment plan is. I believe I'm Fitzgerald Skin Type 3 or 4, and have used silicone sheeting nearly 24/7 since the wounds closed. Please help advise! Thank you. Pictures are from the day of injury (1/16/26) and today (5/18/26).

Anna Chacon, MD, FAAD · Answer

Thank you for the detailed information—this is actually a very common scenario, and it makes sense that you’re receiving different recommendations because both approaches have valid points depending on timing and scar behavior.

At 4 months after injury, your scar is still in an active remodeling phase, which means it is still responsive to treatment and not yet in its final form.

From your description, there are two different components:

A raised hypertrophic area (the circular mound)
Irregular linear/texture changes along the incision lines

These should be treated in a staged way rather than all at once.

1. First priority: flatten the raised scar

The most important initial step is to address the hypertrophic (raised) portion.

The standard and most effective treatment here is:

Intralesional corticosteroid injections (Kenalog)
Sometimes combined with 5-FU in thicker or more resistant areas

This helps:

Flatten the raised tissue
Reduce ongoing scar activity
Prevent further thickening
2. V-Beam laser (if redness is present)

If the scar still has any pink or red coloration, V-Beam (pulsed dye laser) can be helpful.

It works by:

Reducing redness and vascular activity
Helping “calm” the scar
Supporting better long-term maturation
3. Texture treatment (after flattening)

Once the raised component is controlled, then you can focus on improving texture.

Options include:
RF microneedling (more effective for collagen remodeling and contour improvement)
Standard microneedling (milder, more gradual improvement)

For Fitzpatrick skin type III–IV, RF microneedling can be used safely when done conservatively.

4. Fractional CO₂ laser (later stage)

Fractional CO₂ laser can be very effective for refining texture, but in your case:

It should be considered only after the scar is flatter and stable
Used too early, it may increase risk of pigmentation changes in your skin type
Why you’re getting different opinions

Both providers are not wrong—they are just prioritizing different steps:

One is focusing on flattening and controlling scar activity first (Kenalog-based approach)
The other is focusing on early remodeling with devices like lasers and RF microneedling

The key issue is sequence, not disagreement on options.

Bottom line

For your situation, the most balanced approach is:

Flatten first (Kenalog ± 5-FU)
Use V-Beam if needed for redness
Then proceed with RF microneedling or microneedling for texture
Reserve CO₂ laser for final refinement if necessary

At 4 months, you still have a lot of time for meaningful improvement, and a staged approach will give the safest and most natural result.

What are the best treatment options for my nose scar? (Photos)

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