Would subcision help the scar below my lip? (photo)

Question

I have had this boxcar scar on the edge of my mouth for about 2 years now. It wasn’t even from acne, but from a patch of granuloma annulare and that is how it healed. I am 24 and noticing the scar is starting to pull at my lip. I am ashamed of this and it’s the only thing I can see in the mirror. Thinking about subcision and filler, however, nowhere near me offers subcision.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HIDEF 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 acne 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 acne scars and indented acne 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 been 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 laser 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.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne 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

Nelson Lee Novick, MD · Answer

At least from the photos, it would appear that the boxcar scar would be amenable to subcision+/-filler to elevate and smooth it. I have personally been routinely performing subcisions since 1994 for treating all kinds of depressed, indented scars from all causes with gratifying results. It is an inexpensive procedure that has proven safe and effective in all skin types. Unfortunately, as you already have found out, it has been replaced by glitzy, expensive, energy-based devices whose hard science to support its use lags woefully behind the heavy marketing hype to promote them. So, you will likely have to travel in order to receive this treatment. Sorry. Best of luck.

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

Good Afternoon! I see what you're referring to in your pictures. Subcision is an option. As you may know, that helps take any tethering and release the scar so it's not quite as depressed. You can try filler but the results only last 8-12 months. Nanofat transfer helps provide stem cells and growth factors to improve the appearance. Morpheus8 which is microneedling RF can smooth the scar. If all else fails, excision of the scar may be needed. Hope this helps!

Would subcision help the scar below my lip? (photo)

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Would subcision help the scar below my lip? (photo)

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