How can this scar from a nasty fall when I was 1 be removed? (Photo)

Question

I have an old scar on my forehead from a nasty fall I had when I was about a year old. It's just a bit of pigmentation on my forehead and nothing else. How can I get it removed completely? Will I need to do surgery, or will laser treatments be sufficient?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concern. Since your scar is longstanding and mostly shows as pigmentation without much texture, the treatment approach is usually different from fresh or raised scars.

For scars that are primarily pigmented (darker in color than the surrounding skin), non-surgical options often work well. Treatments such as specialized lasers (like Q-switched or fractional lasers) or chemical peels can help lighten pigmentation and blend the scar into the surrounding skin more evenly. Topical lightening agents, sometimes combined with these procedures, may also be used to gradually improve the discoloration.

Surgery is usually reserved for scars with significant texture, depth, or distortion of the skin which doesn’t sound like the case here. Because yours is flat and just pigmented, surgery may not be necessary and could actually risk creating another scar.

In summary, laser treatments are usually sufficient for this type of long-standing pigmented scar, and they tend to provide noticeable improvement over time without the risks of surgery. Multiple sessions are often required, and results can vary depending on your skin type and how the scar responds.

Raffy Karamanoukian, MD, FACS · Answer

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

Nelson Lee Novick, MD · Answer

You would be wise to consider consultation with a board certified cosmetic dermatology to discuss the use of manual microneedling (no need for the added expense or risks for RF microneedling) accompanied by the application of prescription topical pigment lightening agents. Be aware that the use of lasers and RF devices poses the additional risk for the development of post-inflammatory hyperpigmentation, particularly in skin of color. Surgical excision poses the risk for the subsequent development of stretch scars and even tram track stitch marks. So, be very cautious when these options are presented to you. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck. .

How can this scar from a nasty fall when I was 1 be removed? (Photo)

Answers (3)

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