How can I flatten my full-thickness skin graft scar? Will laser resurfacing make it worse? (photos)

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.

Best,
Dr. Karamanoukian
Realself100 Surgeon

There are several options that can help.  Some non-ablative laser resurfacing will help to flatten the scar.  I usually like to do 3-4 treatments with this as it will soften and flatten the scar.  No downtime.  At the last treatment I would add some ablative resurfacing to decrease the height of the scar.  An alternative is micro-needling with radiofrequency such as Infini - do 3 treatments and should see some remolding of the scar with improvement.  Not sure why your surgeon told you to avoid laser.    

Two considerations: (1) If this thickness is a consequence of the way in which you healed, kenalog (cortisone) injections may be helpful in dissolving the excess collagen under the graft. (2) If the graft was too thick from the onset, you may benefit from a minor surgical procedure in which the graft is elevated and “defatted” (remove fat underneath the graft). I doubt that laser resurfacing will be harmful, but I also doubt that it will be helpful.

Either fractionated ablative or non-ablative laser (CO2 or Fraxel 1550) should help this, and often combining it with ReCell may help with depigmentation.  Seek an experienced specialist.  Best wishes, Shobhan.

IF you are concerned, or super conservative, I would recommend the use of fractional lasers as the first step. For pigmentation you can combine Latiesse with narrowband UVB over a trial of 8 weeks. If you find that laser treatment actually helps and your confidence builds up, one can increase the density of coverage. My advice is to consult a plastics or surgical - procedural dermatologist for advice. All the best, Dr Davin Lim. Laser Dermatologist, Brisbane. Australia.