I had a mole removed and it left a crater scar on my nose. What are my options? (Photo)

Question

I had a mole removed and it’s been about 9 months. I have a crater scar on my nose that drives me insane. I’ve talked to some doctors who recommend against filler in the nose or subscision in nose. I’ve also had doctors say that it’s careful business working on scars on the nose because it can scar worse easily. I am considering micro needling to try to improve the edges of the scar so it’s not as visible. What are my options?

Nelson Lee Novick, MD · Answer

Subcision, which is used for elevating and smoothing atrophic (depressed, indented) scars from all causes, is a process that relies on breaking up the tethering fibers that hold the scar down and promoting new, native collagen and elastic fiber synthesis. It does not require the additional use of filler, so the obvious fears and concerns, like skin necrosis or blindness, that have been linked to filler use in the nose, do not really apply to traditional subcision. I have personally been using this approach safely for treating indented shave removal scars, as well as chickenpox and acne scars on the nose, for decades with gratifying results. Once the indentation is elevated and smoothed, then manual, focused Dermastamp microneedling may also be safely used to improve any residual, surface texture and/color irregularities. Surgical excision in this area would be ill-advised in my opinion, since areas under tension like this are likely to develop stretch scars and even tram-track stitch scars that can be more visible than the original scar. And any of the expensive, energy-based, faddish gizmos, like fraxel lasers & RF devices unfortunately have more marketing hype to support their use than hard science. Make sure to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

I would use a combination approach including fillers, subcision, and surface fractional laser.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

David M. Kowalczyk, MD, MBA, FACS · Answer

Hi there! I agree with the sentiments of the physicians you've spoken with. There's always a risk of making a scar worse. You can certainly try microneedling to soften the appearance. I agree with avoiding filler. Nano and microfat transfer are great options for nasal skin. This involves harvesting fat from around the belly button and processing it into smaller parts like stem cells and growth factors. It's amazing what a series of injections can do to help improve a scar. Maybe consider this as an option with a facial plastic surgeon. Hope this helps!

Onir Spiegel, DDS, PhD · Answer

A scar left from mole removal can usually be treated with minimally invasive Morpheus treatment which involves microneedling and radiofrequency applied to the skin during 1-3 sessions for optimal results. At times you may need a subcision procedure and perhaps some filler treatment. Your doctor would probably like to see you in person to give you their best treatment recommendation.

Thomas G. Korkos, MD · Answer

Hello!
I would agree with the physicians you have spoken to about filler and/or subscision due to the highly sebaceous makeup of the nose.
For treatment, Microneedling is one option, possibly with PRP or Exosomes to help stimulate recovery. I would also recommend considering laser skin resurfacing such as BroadBrand Light (BBL) or CO2 Fraxel. While you would likely require a fair number of treatments, the cost per treatment for a small spot like that should be relatively affordable and can provide substantial results.
Best of luck!Dr. Tom Korkos

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