Nose Scar; please help! Will continued CO2 treatments help? (Photo)

Question

Please help. I am so distraught over this. Had an atrophic scar on my nose from sebaceous acne. Had a top plastic surgeon do a scar revision. He says he has never seen anyone's skin heal like mine. He performed CO2 (CO2RE) last Thursday and I see no improvement. Will continued CO2 treatments help? Should I ask about subcision? Sorry, I posted this question before and it cut the second half of it off.

Nelson Lee Novick, MD · Answer

First, let me say that I am sorry that you are going through all this. Unfortunately, I am hardly surprised that you have not had any significant progress after your most recent laser treatment. In my experience, lasers, like many other energy-based devices, that have appeared (and continue to do so) on the market these past few years and are billed as the "next best thing," very often yield inconsistent, variable, or subtle results and all-to-frequently prove themselves to be far more device manufacturer backed marketing hype and much less hard science.Subcision, on the other hand, is a relatively inexpensive technique with a more than two decade backed track record for helping to elevate all kinds of depressed scars. However, it is a procedure that requires no deep cutting and certainly no stitch placement, as with excisional scar surgery. Excision, in my opinion, is procedure that in the area where your scar is located--an area subject to significant skin tension--was not likely to be successful from the get-go.Over the years, I have treated quite a few depressed scars on the nose with gratifying results, using subcision to elevate them, often combined with filler to provide immediate improvement, as well as to contribute to secondary biostimulation of new, native collagen and elastic fiber synthesis (neocollagenesis, neoelastogenesis). Following this, medical microneedling may be used if needed or desired, to help to better blend any residual surface tone and texture problems, such as the stitch track marks, with the surrounding normal skin. This might be the time to consider a second opinion by a board certified core physician with particular expertise and experience in treating nasal scars. I wish you all the best.

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 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 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. 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
Realself100 Surgeon

Jason Emer, MD · Answer

This can be improved with lasers and fillers and subcision.  Microneedling/PRP also may help but a formal consultation is needed to determine what is best.  Dr. Emer.

Stephen Weber MD, FACS · Answer

Resurfacing tends to work nicely for this type of scar. The nasal skin is thick and responds well to both CO2 laser and dermabrasion. For a scar like this I typically will start with dermabrasion and think that the results in a single stage are superior to what you can achieve with CO2 laser. Subcision will elevate the depressed portion of the scar but will not change the surface pigmentation and irregularity of the scar which is will still draw the eye. Best.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Nose Scar; please help! Will continued CO2 treatments help? (Photo)

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Answer: Nose scar treatments

Answer: Nose scar treatments

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Nose Scar; please help! Will continued CO2 treatments help? (Photo)

Answers (4)

Answer: Nose scar treatments

Answer: Nose scar treatments

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Everything you need to know about Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.