Scar post CO2 - how can this be treated? (Photo)

Question

38 F had lip lift deep plane almost a year ago and co2 almost 6 months ago. I have raised incision line and pigmentation where co2 was and where incision line is. When it’s hot outside it swells and my under nostrils look raised from my skin. I hate it. I want a smooth and clean appearance. Please help.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

For other readers of this response, there are two cautionary points worth noting here. One is that invasive, aggressive surgeries entail the risk of stretch scar formation and even the development of tram track stitch marks. The second is that aggressive ablative procedures, like C02 lasers (much like traditional dermabrasion) run the risks for scar formation and dyspigmentation. So, caution is strongly advised when considering these routes for any cosmetic issues. 
For the current problem, the use of intrasional injection of an anti-inflammatory agent can be helpful for shrinking and flattening the surgical scar. Once done, professionally performed manual microneedling (no need for the added expense and risks of RF micro needling) can be used to help better blend the scar in both color and texture with the surrounding normal skin. You would be wise to consult with a board certified cosmetic dermatologist scar specialist. Hope this helps and helps and best of luck.

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