Mohs surgery 10 years ago. Scar revision? (photo)

Thank you for your question and for providing background on your surgical history.

It’s not uncommon for raised areas to persist even years after Mohs surgery, especially if there was tension during closure, underlying fibrosis, or subtle volume loss that alters the skin contour.

Here are several potential options to consider:
1. Steroid Injections (Intralesional Kenalog):
Can help flatten hypertrophic or thickened scar tissue even many years post-procedure.

Best for firm, palpable areas under the skin that have not responded to lasers.

2. Subcision
A minor in-office procedure that releases fibrous bands beneath the skin.

Particularly useful if the area feels tethered or sunken in certain lighting or angles.

3. Microneedling with Radiofrequency (RF Microneedling):
This helps remodel collagen and scar tissue.

Can gradually smooth out raised or uneven skin texture.

4. Laser Resurfacing (Fractional CO2 or Er:YAG):
Although you’ve tried lasers in the past, the type and settings matter significantly.

Fractional ablative lasers may be more effective than non-ablative ones for raised or dense scarring.

5. Filler or Fat Grafting (if atrophic components exist):
If there's adjacent volume loss creating contrast around the raised area, strategic filler or autologous fat grafting can create a more even surface.

6. Surgical Scar Revision (Selective Cases):
If the scar is well defined and discrete, excision and re-closure with precise layered technique may still be an option—even if previously declined. A second opinion from a dermatologist with surgical expertise may be helpful.

Final Thoughts:
Although your scar is over a decade old, scar tissue can still be responsive to treatment, especially non-invasive or minimally invasive techniques. A combination approach, often starting with steroid injections or microneedling, can yield visible improvements over time.

Thank you for your patience in managing this long-standing concern, your persistence is valid, and meaningful results are still possible.

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

Based on the one post, a photo surgical option is indicated for Scott revision with potential micro plasty technique. This can be done under local anesthesia. Fees $1000-$2000 range best of virtual consult with.