Scar revision on forehead: excision or laser? (photos)

Question

How would you treat this scar? Traumatic scar to the forehead just above eyebrow, about 3cm wide and .75cm tall due to railroad marks left behind due to reaction to dissolvable sutures that were placed superficially. Been treating with silicone sheeting, SPF, and massage daily. Started implementing tretinoin about six weeks ago. One dr said laser, one said dermabrasion. I would like to have it excised and reclosed but concerned it would raise the eyebrow to unnatural position. Serial excision?

Nelson Lee Novick, MD · Answer

The hard science to support using expensive fraxel lasers lags woefully behind the heavy marketing and social media hype to promote them. So, buyer beware. IPL is unlikely to do much, if anything at all, for this kind of scar. Surgical revision in areas, such as this, under tension run the risk for the development of stretch scars and tram track stitch marks. CO2 lasers, much like dermabrasion, are aggressive procedures that run the risk of prolonged and persistent healing, scarring and post-inflammatory pigmentary changes. If the scar is indented, subcision can elevate and smooth it, following which manual professionally performed microneedling can help as a "polishing" step to better blend the treated scar with the surrounding normal skin. You would be wise to consult a board certified cosmetic dermatologist. Best of luck.

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