What procedures should I consider to flatten my forehead scar? (Photo)

Question

I had CO2 laser, subcision, punch excision and RF microneedling to get to this point with the scar I have on my forehead, but it’s still very deep. What other procedures should I consider that could help flatten my scar?

Anna Chacon, MD, FAAD · Answer

When dealing with a deep forehead scar that has not responded fully to treatments like CO2 laser, subcision, punch excision, and RF microneedling, there are still several options you can consider:

Fractional Laser Resurfacing: While you've tried CO2 laser, other types of fractional lasers, such as erbium lasers, might offer different results. These can stimulate collagen production and help in further smoothing the scar.

Dermal Fillers: Temporary fillers can be injected beneath the scar to elevate it to the level of the surrounding skin. This can be particularly effective if the scar is depressed.

Silicone Gel or Sheets: Regular application of silicone gel or sheets can help in softening and flattening the scar over time. These are non-invasive and can be used in conjunction with other treatments.

Surgical Scar Revision: In cases where non-surgical methods are insufficient, a surgical approach may be considered. A plastic surgeon can remove the scar tissue and realign the skin for a more aesthetically pleasing result.

Chemical Peels: Depending on the depth and type of your skin, certain chemical peels can help in resurfacing the skin and reducing the appearance of scars.

Platelet-Rich Plasma (PRP) Therapy: PRP can be used to promote healing and improve skin texture by stimulating collagen production.

Consultation with a Specialist: It’s important to consult with a board-certified dermatologist or plastic surgeon who can evaluate your specific case and recommend a tailored treatment plan.

Each of these options has its own benefits and considerations, so a professional evaluation is essential to determine the most appropriate course of action for your specific scar type and skin condition.

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

There are certain general principles that are important to emphasize when it comes to treating Indented scars. For  "mature" scars, defined as those over three months of age, a realistic likelihood for more than achieving between a sixty to eighty percent overall improvement in appearance is low. And, for treatments, such as subcision, which I have been performing for nearly thirty years, and which has an excellent safety and efficacy track record for elevating and smoothing all kinds of Indented scars, it usually takes somewhere between two to six treatment sessions (on average three or four) in order to achieve maximal elevation improvement. Very few people are lucky Lotto winners and achieve their maximal improvement after only one or two treatment sessions. Following this, manually performed Dermastamp microneedling (really no need for the added expense and risks of RF micro needling), which is best reserved for treating superficial, surface texture and color irregularities, can be performed in order to better blend the surface of the scar with the surrounding normal skin. So, if you have not already undergone a full series of subcisions, you may wish to discuss this with your treating physician, and you would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck.

Jeff Rapaport, MD · Answer

Enerjet is a non-surgical treatment option for improving the appearance of scars, including forehead scars. It combines a proprietary air-pressure technology with the delivery of bioactive compounds like hyaluronic acid or other regenerative substances to stimulate skin repair and remodeling.
Jet Volumetric Remodeling (JVR): Enerjet uses high-pressure, needle-free technology to deliver tiny jets of therapeutic agents directly into the skin. These jets penetrate the dermal layers, breaking up scar tissue and stimulating natural healing processes without cutting the skin.
Scar Subcision: In the case of scars, such as those on the forehead, Enerjet can function as a form of non-surgical subcision. The force of the jet disrupts the fibrous bands tethering the scar to underlying tissues. This allows for smoother skin texture and improved elasticity.
Skin Remodeling: The introduction of bioactive substances (e.g., hyaluronic acid) promotes collagen production, improving the overall appearance of the scar by restoring skin volume and smoothness.
Minimally Invasive: Enerjet is needle-free and does not require surgical intervention.
Short Recovery Time: There is minimal downtime, with most patients experiencing mild redness or swelling that subsides within a day or two.
Effective Results: Patients typically notice a gradual improvement in skin texture and scar appearance over several weeks to months.
 Multiple sessions may be required.
Enerjet is particularly suitable for individuals seeking non-invasive solutions for scars or skin rejuvenation without the risks associated with surgery. Consult an expert dermatologist. 
Jeff Rapaport MD FAAD 
Realself Hall of Fame 
Castle Connolly Top Doctor

Keera Kang, MD · Answer

Hi Zoltai :)First of all I am sorry all of those treatments have not worked for you. You have tried all the lasers that I would've recommended to my patients as well. But did you do additional injections with those lasers? From the picture I am assuming it is a depressed scar (atrophic scar). What I usually do is do some subcision, then do a laser with a PDRN or PN injection.Also you can try just PN injections (Rejuran S) or even PDLLA(Juvelook skin) injections for the depressed scars without the laser bc it will help with collagen synthesis and help improve the depression. And if that doesn't work, I inject small amounts of filler into that area to fill in the depressed part of the scar even it is only for temporary purposes since my patients are satified with it. I hope this helped and please visit an experienced cosmetic dermatologist for the best results. Good luck and you are beautiful so don't forget that :))

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