Permanent Lines Post Laser. Does anyone have a solution? (Photo)

Question

Roughly 4 months post ablative erbium resurfacing, these linear depressed lines appeared. They itched during arrival. They appear dynamic and move with the skin. Original physician has no idea what they are or how to treat. I have met with every PS and derm in my area and nobody has ever seen this before let alone how to treat. Everyone just wants to use more lasers. Has anyone seen this before? Does anyone have a solution? Willing to travel.

Mats Hagstrom, MD (license on probation) · Answer

When making an assessment like this, it’s important to differentiate. If the problem is it all related to pigment changes or color or if it’s contour related. It looks like you have contour changes and that this is not related to skin pigmentation or color.
My best guess is your treatment caused some fat atrophy probably in areas where the laser overlapped. It would be very helpful to know what the laser treatment pattern was. Did the surgeon go in longitudinal lines that follow the lines on your scalp? Did the provider overlap the laser treatments?
Contour irregularities from fat atrophy from thermal energy from a laser treatment or other radio frequency treatments can be challenging. If it’s purely volume related then very careful volume restoration may be of some benefit. Whether that’s a worthwhile treatment is another story.A lot depends on how motivated you are and what you’re willing to go through to get partial improvements. If this is purely related to contour, then very careful injections with dilute filler could improve the situation, but obviously fillers are temporary. Grafting fat is much more unreliable and probably isn’t going to, give you the results you’re hoping for. In the end there may be nothing that can be done that’s realistic and appropriate. It’s important. Your provider is aware of the long-term outcome so they can adjust their technique for future treatments and not cause the same problem on other future patients. To make a quality assessment on the outcome of a procedure we generally need to see quality before and after pictures. Did your provider happen to take before pictures? Do you have pictures from the past showing what your scalp used to look like?
If your provider took pictures, then get your before and after pictures from your provider.
I can’t think of anything other than fat loss, as being the reason for the contour irregularity, and that can happen whenever you do treatments that purposely induce trauma to tissues.
Best,
Matt Hagstrom, MD

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