Flat dark hypertrophic scar on right side of nose (Photo)

Question

Hi everyone I was wondering how to get rid of a hypertrophic scar on the nose. I’m a young brown skin female who does get hyperpigmentation but definitely fades within a year or year and a half. What cause the hypertrophic scar was a piercing that got infected. I was told that co2 laser, micro needling/ dermabrasion with combination of steroid injections, or scar revision could work. What’s the best treatment to get for my brown skin tone?

Nelson Lee Novick, MD · Answer

I am really distressed to hear that you have been inundated with proposals for this or that expensive "bells and whistles" treatment. The general rule of thumb for anything is "the simplest solution is generally the best solution."  The scar appears slightly elevated in the photo (not flat), which would be expected in a true hypertrophic scar. And, in the case of hypertrophic scars, particularly small ones, as in this case, a relatively inexpensive and extremely quick intralesional injection of a steroid would be the first go-to. Make sure that you consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 been 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 laser 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 acne 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

Flat dark hypertrophic scar on right side of nose (Photo)

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