How do I fix indented scar that has filler around it? (Photo)

Question

Why wouldn't filler fill in a scar but go around it. How do I fix and indented scar that has filler around it?

Nelson Lee Novick, MD · Answer

The reason for filler-related bumpy elevations around indented scars is pretty simple to answer. Indented scars are held down by bands of thick tethers of scar collagen--hence to the visible depression on the skin surface. These bands of scar collagen can act as barriers to the addition of filler, such that the filler instead of being able to get in easily under the depressed portions of the scar to elevate them instead end up flowing into the normal areas surrounding the scar that offer less resistance, which accounts for the bumps around the scar. If the filler used was an HA filler, it can be dissolved with hyaluronidase. If a semipermanent or permanent filler was used it can be difficult to treat, I have fortunately had personal success using an algorithm of varying combinations, concentrations and amounts to treat this kind of issue. 
More appropriately, this type of problem should be treated from the getgo first by subcision to break up the tethers and elevate and smooth the scar and then, if necessary, an HA filler may additionally be used. In this case, since the tethers have been broken up by the subcision, the filler is unlikely to spread to the surorunding normal skin and hence no surrounding bumps. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist scar specialist. Hope this helps and best of luck.

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

How do I fix indented scar that has filler around it? (Photo)

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How do I fix indented scar that has filler around it? (Photo)

Answers (2)

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Our mission is to create a world where every investment in modern beauty is Worth It.