Which procedure would help minimize the appearance of hypertrophic scarring on the nose caused by acne?

Question

I have had these painless bumps on my nose for years now and they don't seem to go away. I tried something called "smoothbeam" laser and it didn't work as much as I hoped. My current dermatology has: Fraxel Dual 1550nm laser, SmartXide DOT Fractional CO2 Resurfacing, Microneedling with PRP, TCA Cross, Cortisone Injections. Any treatments from the list you think would work effectively against this type of scarring? And how many treatments would you say I need? Thanks.

Nelson Lee Novick, MD · Answer

The history and the overall appearance of the bumps is consistent with papular acne scars--a form of hypertrophic scars due to acne. If this is indeed so, then I have had success treating these over the years using intralesional anti-infllammatory agent injections to flatten them, and, when necessary, the supplemental use of either Scalpel Sculpting or light electrocautry for flattening more resistent bumps. I typically perform a test of each modality on a representative papular acne scar before proceeding with treatment of all the troubling lesions. Exercise a healthy dose of buyer beware when offered all kinds of relatively expensive "bells and whistles" fraxel lasers and RF devices, as the hard science to support these gizmos lags well behind the heavy marketing to promote them.  Make sure to  consult with a board certified cosmetic dermatologist with expertise in acne scar treatments and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing.
 
As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.
If you have ice-pick scars, we recommend RF ablation and TCA Cross.
Best,
Dr. Karamanoukian
Realself100 Surgeon

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