Bumps after subcision & texture looks worse throughout day - do you recommend kenalog or electrocautery? (Photos)

Hi there,

Thank you for your detailed question — I understand how frustrating it can be to deal with persistent texture changes after subcision and filler.

From your description, it sounds like you’re experiencing post-procedural hypertrophic or fibrotic changes, where the area feels flat to the touch but appears raised, especially throughout the day. This may be related to tethering, scar tissue buildup, or subtle dermal remodeling that can happen after filler and subcision.

Let’s break down your options:

Kenalog (intralesional corticosteroids):
This can help flatten true hypertrophic or raised scar tissue, especially if there is ongoing inflammation or collagen overproduction. If the bumps were improving (even subtly) after one injection, additional sessions might lead to further benefit. However, overtreatment can cause skin thinning or atrophy, so a conservative approach with low-dose Kenalog (e.g., 2.5–5 mg/mL) is recommended.

Your second dermatologist's concern is understandable—if the area truly feels flat, further steroid injections could risk unnecessary tissue loss. But if the appearance is still affecting you cosmetically, another session may be reasonable with proper assessment and technique.

Electrocautery:
This is typically used to treat superficial, raised lesions like sebaceous hyperplasia or small keratoses, but it can flatten mildly elevated scars in some cases. It’s more destructive than Kenalog and carries a higher risk of pigment changes or further scarring, especially in sensitive or facial areas. It’s generally not first-line unless the area is clearly raised and well-demarcated.

Other options worth considering:
Microneedling with RF (radiofrequency): Helps remodel deeper scar tissue and improve surface texture without aggressive ablation.

Laser treatments (e.g., Fraxel or CO₂): Can help blend texture irregularities over time, especially when scarring is shallow but visually noticeable.

Silicone-based scar gels or sheets as adjuncts for raised scars.

My recommendation:
If the area looks visibly raised but feels flat, I would lean toward another low-dose Kenalog session with a conservative provider who understands the nuances of post-subcision healing. Electrocautery may be too aggressive unless the bump is definitively raised and focal.

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

Based on your posted photos and other treatments, I might consider trying the Endo treatment with micro dermabrasion combination. Best of virtual concert with fee $2500. Again, best of virtual concert with.