Best procedure to improve my scarring? (Photo)

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

Treating your postauricular raised keloidal scar with these methods offers the simplest, cost effective approach and has several benefits:

1. Bleomycin , 5-fluorouracil or corticosteroid intralesional injections: These medications help reduce scar tissue by inhibiting the abnormal growth of fibroblasts, which are responsible for collagen production in scars. They can effectively flatten keloids and reduce their size over time.

2. Cryotherapy:This involves freezing the keloid with liquid nitrogen, which helps to reduce its size and alleviate symptoms like itching and pain. Cryotherapy can also improve the appearance of the scar by flattening it and reducing redness.

3. Silicone topical gel or sheeting: Silicone products provide a protective barrier over the scar, helping to hydrate the skin and regulate collagen production. This can lead to softer, flatter, and less noticeable scars over time. Silicone gel is also effective in reducing itching and discomfort associated with keloids.

Combining these treatments can often yield better results than using them individually, as they target different aspects of keloid formation and help prevent recurrence. However, it's essential to consult with a dermatologist / scar expert.. Good luck.

Jeff Rapaport MD FAAD
Realself Hall of Fame
Castle Connolly Top Doctor

It's unfortunate to hear that your scarring has not improved as much as you'd hoped. Here are some recommendations you may want to consider discussing with your physician:

1. Silicone Gel or Sheets: Silicone products have been shown to help reduce the appearance of scars. They work by creating a protective barrier over the scar, which helps to maintain the skin's moisture balance and boost the healing process.

2. Laser Therapy: Laser treatments can help to smooth and flatten scars, as well as correct red and dark pigmentation issues. It's important to note that multiple sessions may be required to achieve the desired results.

3. Microneedling: This procedure involves the use of tiny needles to puncture the skin and stimulate collagen production, which can help to improve the texture and appearance of scars.

4. Dermabrasion: This is a procedure that exfoliates the top layer of your skin and helps to improve the appearance of scars.

5. Topical creams or gels: Some over the counter or prescription creams, gels, or ointments that contain retinoids or vitamin E may also help to improve the appearance of scars.

6. Injections: For raised scars, steroid injections or injections of other medications can help to flatten the scars and reduce their appearance.

7. Surgical revision: In some cases, a scar revision surgery may be beneficial. This involves removing the scar tissue and re-suturing the wound, often using special techniques to minimize the appearance of the new scar.

Remember, it's crucial to consult with your healthcare provider before starting any new treatment. They can provide advice tailored to your specific situation and help you understand the potential risks and benefits of each option.

At least from the photo provided it would appear that intralesionally injecting the appropriate concentrations and amounts of anti-inflammatory agents should help to significantly flatten the scars. Revision surgeries carry the risk for the subsequent re-development of hypertrophic scars (as in this case), stretch scars and even tram track stitch marks. So, I am not surprised with the lack of success with the revision surgery. You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist, and best of luck.