How to remove this atrophic scar? (Photo)

Question

I'm writing here after 5 long years of struggle with this scar. Long story short I had one deep acne scar which was recommended by a surgeon to be removed surgically.Unfortunately this decision destroyed my life. He made a vertical line/cut on my face and while healing there was ingrown hair follicle which caused inflammation and the whole thing became swollen and red. After long time of taking antibiotics and pulling this hair out, the scar became severely atrophic and uneven with the skin (not leveled) Unfortunately it became atrophic and all the procedures I tried did not work. Microneedling 30x plus times, RF Microneedling, Laser , Chemichal Peeling and Fillers did not work. In the 5 years of treating this scar and spending close to 15000€ on treatments I got all together maybe 5% improvement. What should I do? Is the surgery only option? Is there any option and help? Basically this thing destroyed my life and my self confidence.

Raffy Karamanoukian, MD, FACS · Answer

Scars can be temporary or permanent and there are many aspects of scars that can be improved. During your consultation, we look to determine the textural changes, hypopigmentation, hyperpigmentation, scar color, scar contour depth, scar atrophy, inflammation, and scar thickness. Once complete, a HIDEF protocol is established that includes pigmentation protocols to either lighten or darken scar tone, retexturization of scars, inflammatory mediators, lasers, and contour correction. All of these require time and multi-plane correction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I'm so very sorry that you are going through this. Subcision, for elevating and smoothing alll kinds of indented (atrophic, depressed) scars, from all causes, has a proven track record for efficacy and safety gong back to 1994 when I first began to perform it for these purposes. You would be wise to consult an experienced, board certified cosmetic dermatologist to explore this simple and relatively inexpensive option. Unfortunately, I have been cautioning my regular readers for years that surgical revisions of scars in locations subject to a great deal of movement or static tension risk the development of stretch scars and in many cases even the development of tram track stitch marks. I have also been cautioning my readers to exercise a great deal of "buyer beware" when evaluating faddish, "bells and whistles" fraxel lasers and RF devices, since these, to date, are backed far more by marketing hype than hard science. I have further cautioned that superficial peels and microneedling can be very helpful for dealing with superficial surface irregularities in skin color and texture, but they had little chance of improving a deeper scar. Once again, make sure to consult a scar specialist and not any venue hawking it's newly purchased "next big thing" light or energy-based device.  Hope this helps, and best of luck.

Daniel Barrett, MD · Answer

Dear luke55,
it is hard to tell for sure without an examination. If you are considering treatment, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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