How to treat a 20 year old hypertrophic scar? Would subcision be a good option? (Photos)

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

I have been performing submissions for thirty years. Subcision is an excellent method for elevating and smoothing indented scars; it is absolutely not a good idea to use for elevated, hypertrophic (or keloid scars). For elevated scars, the intent is to flatten them. And for this, the injection of an anti-inflammatory agent, such as triamcinolone has a more than half century track record for flattening elevated scars.
Once flattened, if there is hypopigmentation that still bothers you, then manual microneedling (no need for the added expense and risks of RF microneedling), accompanied by the application of Rx pigment enhancers, can be used to better blend the scar in color and texture with the surrounding normal skin.
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Best of luck.