How to correct atrophic scar on cheek? (Photo)

Question

I had a cyst removed nearly 2 years ago, then a series of laser treatments (BBL and profractional), as well as some relatively deep microneedling. The scar is pretty much gone, but nothing seems to be addressing the atrophic quality of the area. What are my options? Prefer something permanent. Sick of seeing a dent in my face after all this work with lasers and microneedling. Thanks!

Anna Chacon, MD, FAAD · Answer

Atrophic scars, especially those left behind after cyst removal, can be challenging to treat because they result from a true loss of dermal tissue. While lasers and microneedling can improve texture and stimulate collagen, they often don’t completely address volume loss.

For persistent atrophic scars, several options may be more effective:

Dermal fillers: Hyaluronic acid or biostimulatory fillers (such as Sculptra or Radiesse) can restore volume in the area and lift the indentation. These are not permanent but can last from 1–2 years, and in some cases, stimulate new collagen.

Fat grafting: Using your own fat harvested from another part of the body, this approach can permanently replace lost volume.

Subcision: This technique involves breaking up scar tissue underneath the dent with a fine needle, allowing the skin to lift. It is often combined with filler placement for optimal results.

Punch excision or surgical revision: For certain types of scars, a minor surgical procedure to excise or revise the scar can yield long-term improvement.

Since your scar has already been resistant to laser and microneedling, addressing the volume deficit directly through filler or fat grafting, sometimes paired with subcision, is often the most effective path toward a more permanent correction.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

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