What's the best way to remove chicken pox scars? I want to avoid filler (Photos)

Question

I have chicken pox scarring on my face, the scars have been on my face since childhood so they are not new. What is the best procedure to remove them or smooth them out? I want to avoid filler. I am aware that punch excision and subcision can leave scars but I would rather have a flat scar that I can easily cover with makeup and treat with laser after than the current chicken pox scars I already have.

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

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. For treating longstanding chicken pox scars, Morpheus8 can be an effective option to consider. This advanced treatment combines microneedling with radiofrequency energy to stimulate collagen production and enhance skin texture. Since your scars have been present since childhood, Morpheus8 can help to smooth out the unevenness associated with them, promoting a more uniform appearance without the need for fillers. Morpheus8 works by delivering targeted energy deep into the skin, encouraging the body’s natural healing process. This can significantly improve the appearance of scars over time, as the increased collagen production helps to fill in and soften the scar tissue. The procedure is minimally invasive, making it a suitable choice for those looking to avoid more aggressive surgical options. After a series of treatments, many patients report a noticeable improvement in the texture and tone of their skin. Although you might see some redness and swelling immediately after the procedure, these typically subside within a few days, and the overall recovery time is relatively quick. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

First, let me start by saying that while punch excision, which requires cutting through the surface of the skin and the placement of sutures, does risk the subsequent development of stretch scars and tram track stitch marks, subcision, which I have been performing since 1995, has little to no risk for these problems since subcision requires no cutting on the surface of the skin and, therefore, certainly no need to place any stitches. "Sub" means under and "cision" means cutting, I.e. cutting UNDER the skin. Excision means to cut something out through the skin. So, a punch excision means to cut something out through the skin and hence the risks for stretch scars and stitch tracks. 
A properly performed subcision does NOT require the use of a filler to be effective. It is an entirely natural process whereby scar tethers are broken up and a blood pocket allowed to form under the skin, which contains natural growth factors and wound healing factors that stimulate new healthy collagen and elastic fibers that will serve to permanently elevate the base of the scar. 
Finally, chickenpox scars typically have very steep scar walls that pallisade around the central indentation. It is therefore often necessary to apply either TCA to the walls of the scar or to use light electrocautery in order to make the walls more rolling (and therefore more malleable) prior to the actual subcision. 
Fraxel laser treatments, much like RF treatments, are backed by a whole lot of marketing hype and social media buzz and not much hard science. So, use "buyer beware" when being hawked these kinds of expensive treatments. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Best of luck.

Mats Hagstrom, MD (license on probation) · Answer

The best way to restore A smooth three-dimensional contour is with direct excision and repair.
Excision should have a 4 to 1 length to width ratio, making the scars quite long.
A scar That has a perfect contour is barely visible in comparison to any scar that still shows contour irregularities.
People are often apprehensive and upset at the length of scar necessary to get a perfect contour and for that reason, people often turn for lesser procedures that tend to fail.
No other procedure will give you a smoothFillers will not work and subsicion will only return with potential worse, long-term outcomes
These are not easy to treat.
Best,
Mats Hagstrom MD

What's the best way to remove chicken pox scars? I want to avoid filler (Photos)

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What's the best way to remove chicken pox scars? I want to avoid filler (Photos)

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