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First, let me emphasize that while unfortunately, with our current technologies, no mature scars can be completely eliminated, they can, however, be improved significantly. Although the photo provided is not optimal, it appears that the scars are indented, as well as having stitch tracks. If so, my approach would be first to elevate the scars using subcision (with or without the addition of a filler). Once this is achieved, if still felt to be necessary, any remaining surface textural and tonal irregularities (i.e. the stitch tracks) may be further improved via microneedling (aka fractional microneedle resurfacing).. Although fraxel lasers are often marketed heavily for scar treatment, the procedure is relatively expensive and the results tend to variable and unpredictable. For more information on subcision and fractional microneedle resurfacing, you can check out the archives or Realself.com. Be sure to see treatment by a physician expert in scar treatment and make sure to ask to see his/her before and after photos.
Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started. Best, Dr. Karamanoukian Realself100 Surgeon
Your scars are well matured and your options include scar revision, dermabrasion and laser. Seek out a board certified plastic surgeon. Also check out the link below to an article I wrote about scarring. Good luck.
Often old scars get more noticeable as we age as the natural color of the skin can darken and the texture around the scar changes. The white scar tissue will stay the same color and may become depressed over time. This following would be my recommendation: Get on a skin care program with Retin A and bleaching agents to even out your background skin. (Do this for a few weeks.) In the photo it looks as though you may be getting some extra pigment on your baseline skin. I would then have you consider something like microneedling to start with. As your skin is dark you may want to start with an in office medical microneedling treatment as this does not generate heat. Heat can cause a rebound of hyperpigmentation for patients with extra pigment on their skin. Watch and see how the skin lightens to your normal color and make sure you don't overreact to any treatments. If your skin is tolerating these treatments well, usually 3-5 treatments at 2-4 week intervals, you may consider a non ablative treatment next with a laser if the skin/scar tissue is still obvious. I would NOT recommend surgery to remove the scar. I would really have you work with blending the color out. Of course you should wear a sunblock with zinc oxide or titanium dioxide daily. We also know using an antioxidant along with or in your sunblock will block out infrared rays also. A typical common topical antioxidant is Vitamin C. Good luck!
