Should I have a subcision and more Bellafill, or have the depressed scar and old Bellafill removed? (Photo)

Question

I have a depressed line scar and it won't go away. I have tried everything. I didn't have a subcision and the Bellafil filled the area around the line scar. Should I have a subcision and more Bellafil or have the depressed line scar skin removed and the old Bellafil underneath the line scar as it's very puffy and makes the scar look worse?

Mats Hagstrom, MD (license on probation) · Answer

This response was dictated using Word recognition.
My apologies for potential grammatical errors.
It’s very difficult to give you a quality assessment from the pictures you’ve included.
If your provider has proper before, and after pictures, then ask for copies of those and post those pictures if you want a better assessment.
Treating skin depressions due to scar tissue from injuries, surgery or deep acne scars is intrinsically difficult.
 it may seem tempting to believe that volume should easily fix the problem but the problem is the rarely volume related.
Skin contour irregularities from connective, tissue or scar tissue like cellulite or acne scars can be made worse by adding volume.
The primary problem is not volume related.
It’s more like tufted furniture like sewn in buttons to create texture on a leather sofa.
Subs scission with filler is a good attempt but eventually the body will respond to the surgical intervention by making more scar tissue.
In plastic surgery literature the textbook answer for Icepick. Acne scars is direct surgical excision.
This in reality is rarely done, but can give very high-quality results.
I don’t know if your scar is amenable to this because I don’t think it’s an acne scar.
Scars from surgical excision on the face if repaired meticulously can become close to invisible.
It is often a good trade-off if the contour is dramatically improved.
There are many variables to take in the consideration, such as skin complexion, the anatomic location anticipated healing, and there is no right or wrong.
Your previous providers approach was theoretically sound, but as I mentioned earlier, adding volume to contour, irregularities due to contractile forces from scar tissue or connective tissue can inherently make things worse.
Grafting fat in the buttocks on individuals with significant cellulite can make the cellulite worse.
If you want quality assessment you’ll need in person consultations.
My best guess is that providers will recommend restoration using fillers.
If you want quality assessment you’ll need in person consultations.
My best guess is that providers will recommend restoration using fillers.
facial contour is highly complex, and there are many variables to take in the consideration including tension of the many muscles of facial expression, loss of skin elasticity, due to age, etc. etc.I don’t think there is a single, simple, straightforward solution to your problem.
When that’s the case, patients need to recognize that attempts at improvement will come with uncertainty, including the potential of possibly making things worse.
Whether intervention is indicated or not becomes a more difficult Decision. 
Best,
Mats Hagstrom, MD

Should I have a subcision and more Bellafill, or have the depressed scar and old Bellafill removed? (Photo)

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Should I have a subcision and more Bellafill, or have the depressed scar and old Bellafill removed? (Photo)

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Everything you need to know about Subcision

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