Atrophic scar on my nose, need advice (Photo)

Question

I have an atrophic scar on my nose that severely affects my mental health and social life. I was injured in May 2023 and had two unsuccessful surgeries. The 1st surgery failed due to inflammation and tension, leading to the wound reopening and healing poorly. The 2nd surgery was better but the scar widened again. The scar now has thin, abnormal skin, it looks like a dent when pressed and flat otherwise, while the other side of the nose tip is convex. What’s the best solution?

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

If you look through my Realself answers over the years you will see that I have answered this kind of question on a number of occasions and that I have warned readers that traditional surgical scar revision surgeries on the nose, and area under static tension, can lead to the development of stretch scars and even tram track stitch marks. So, I am not surprised by the current problem.
You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist regarding the use of subcision, a simple technique that I have been performing for nearly thirty years, for Elevating and smoothing the Indented scar on your nose. One done, you may wish to consider professionally performed manual microneedling (no need for the added expense or risks of RF micro needling) to better blend in both color and texture the superficial surface of the scar with the surrounding normal nasal skin. Hope this helps and best of luck.

Atrophic scar on my nose, need advice (Photo)

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Atrophic scar on my nose, need advice (Photo)

Answers (2)

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