Permanent scar removal options? (Photo)

Question

I have a 1 cm long by .0.5 cm wide hyperpigmented atropic box scar on and under my labiomental crease. I think it is the result of a combination of multiple scars compounded and maybe a tiny mole. I say this because at times, the scar looks somewhat layered up close and different in different angles of light. It darkens and lightens on different days quite randomly and is unfazed by skin lighteners. Subcison, microneedling and peels don't work. In 2024 I know there is a way to clear this.

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

Jason Emer, MD · Answer

It's difficult to determine the best solution for you without the benefit of a formal evaluation. Generally speaking, scars can be improved with a combination of surgery and/or lasers and microneedling with PRP. Below is a more detailed reference list of the treatments available. I recommend getting a formal evaluation with a scarring expert to determine which is best for your specific case. 
Options can include:
1. Vascular lasers (BBL, Yellow laser, V-Beam, Excel V) 
2. Fractional lasers (Fraxel, Erbium, CO2, Halo) 
3. Microneedling/PRP 
4. Silicone-based scar gels with growth factors 
5. Excision/revision surgery 
See an expert to develop a treatment plan that works for you. Best, Dr. Emer​

Jeff Rapaport, MD · Answer

The treatment for a hyperpigmented atrophic boxcar scar typically involves a combination of topical treatments, such as retinoids, hydroquinone, and vitamin C serums, along with procedures like laser therapy, microneedling, subcision,  chemical peels, or dermal fillers, depending on the severity and depth of the scar. 
In your case a fractionated erbium or CO2 is the first step. This would be followed by a Hyaluronic Acid filler if still needed. Pretreat with bleaching cream to prevent hyperpigmentation. Find a scar expert.
Jeff Rapaport MD 
Realself Hall of Fame 
Castle Connolly Top Doctor

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