Dented Scar After Post Op Infection, What Are My Options? (photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. 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 decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Unfortunately, the quality of the photos provided make it difficult to actually appreciate the scar. However, from the description provided,  the scar is depressed (i.e. sunken below the level of the skin). I have found that such scars respond well to subcision. Subcision is a procedure is which a sterile needle is inserted under the scar, following numbing with local anesthesia. The needle is used to break up the thick bands of fibrous scar tissue that bind the area down, essentially freeing the surface tissue to "float:" to the surface. In addition, breaking up underlying scar tissue in this fashion allows for new, healthier collagen to be produced to replace it. Generally one to four treatments are required for optimal effect, spaced at six to eight week intervals (The precise number depends upon how good a collagen maker the person is).

To improve the surface color, and to attempt to match it  better to the surrounding normal skin, the use of a Dermaroller or medical microneedling may be used, either alone or in combination with subcision. The Dermaroller is a manual rolling device that contains arrays of sterilized needles capable of piercing the skin to make microchannels (usually perfomred under local or topical anesthesia) that disrupt the surface of the scar allowing for the possibility of improving scar coloration. The penetration of the needles also further breaks up the scar tissue and stimulates new healthy collagen formation with the result being a smoother, more normal appearing spot.

Finally, in the event there is still some depression after the above measures, a semipermanent volumizing agent, such as Radiesse, may be used to elevate and smooth the surface of the scar still further.

 

 

Your photos don't well delineate your depressed scar. However, for your general situation there may be two options: scar revision and/or fat injections. In order to determine the most appropriate treatment as well as the associated costs, you would need to be examined by a board certified plastic surgeon. 

 

It sounds like you may need a scar revision to improve the indentation. In order to determine this an in office exam would be essential.

Although difficult to appreciate from your photos, it appears that you have some depression on your abdomen from the infection. There are several options that range from a scar revision to fat grafting to the area to help elevate the depressed skin. You would need to see a plastic surgeon in-person to help better understand your options. 

Scars are indented because the skin has no support leading to a collapsed surface. Correcting it would require removing this widened scar and after bringing the fat tissue underneath it together to act as a support stitch the skin edges together under no tension. The cost will vary widely based on where you live with the cost in NY would be higher than in smaller communities. 

I can't see well in your dark photo but generally an indented abdominal scar can be revised and the dent repaired under local anesthesia.  Costs will vary with each surgeon but might be about $2000.