Punch excision on sidewall of the nose (for acne scarring)?

Question

Hello doctors, I have a few depressed/atrophic scars on the sidewall of my nose (boxcar and rolling) that seem to be resistant to the previous treatments. Is it possible to to correct scars on this area of the nose? P.S I do not mind linear scars at all, id much rather have those than depressed scars. Please respond as i am at my wits end and these scars have caused so much distress in my life! Thank you.

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

In areas under a great deal of static tension, such as the nose, there is a real risk following any kind of excision (including punch excisions) for the subsequent development of stretch scars and even tram track stitch marks, which can be quite unsightly, especially in an area as prominent as the nose. You may wish to consider subcision to elevate and smooth these scars. I have been performing since 1995 with very gratifying results in any area of the face and body in all skin types. You would be wise to consult with a board certified cosmetic dermatologist with extensive experience in subcision and be wary when being offered all kinds of "bells and whistles" fraxel laser and RF treatments as the hard science to support the use of these expensive gizmos lags well behind the heavy marketing to promote them. Best of luck.

Punch excision on sidewall of the nose (for acne scarring)?

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