Scar removal methods and risks - is laser the best option or will excision be necessary? (Photo)

I am really sorry this has happened to you. It is for this reason that for removing facial moles (even flat ones) for cosmetic reasons, I personally perform Scalpel Sculpting in order to minimize the scooping-type injury seen in the photo.
I share your concerns about surgical excision, since, especially in areas like the cheeks subject to a great deal of muscular movement, there is a risk for the subsequent development of stretch scars and stitch tracks.
I would urge a great deal of "buyer beware" caution when evaluating lasers and other "bells and whistles" devices as the hard science to support their use lags well behind the heavy marketing and social media hype to promote them. All too often, these hyped gizmos are "here-today-and-gone-tomorrow."
Instead, I would consider the use of simple subcision to elevate and smooth the scar, followed, if necessary by professionally-performed, simple, manual Dermastamp microneedling (no need for the added expense of risks of adverse reactions from RF microneedling) accompanied by the application of Rx pigment-enhancing topicals in order to better blend the surface color and texture of the scar with the surrounding normal skin.
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist and best of luck.

Thank you for your question and for sharing your concerns. It’s very common to want to improve the appearance of a scar, especially on the face, even if it’s subtle.

Scar Treatment Options:

Laser Resurfacing:
For small, atrophic (slightly indented) scars on the cheek, fractional laser resurfacing (such as fractional CO2 or erbium lasers) is often an excellent first-line option. Lasers can help smooth the skin’s surface, stimulate collagen production, and blend the scar with the surrounding skin. The risks are generally low, especially in lighter skin types, and downtime is usually minimal. Multiple sessions may be needed for optimal results.

Scar Excision:
Surgical excision involves removing the scar and closing the area with fine sutures to create a new, linear scar. This can sometimes improve the appearance, especially if the original scar is wide or irregular. However, any surgical procedure will result in a new scar, and there is always a risk—albeit low in your case—of the new scar being more noticeable or developing into a hypertrophic (raised) scar.

Risk of Hypertrophic Scarring:
On the cheek, especially in a 30-year-old white male without a personal or family history of abnormal scarring, the risk of developing a hypertrophic scar after excision is relatively low. The face tends to heal well, and hypertrophic or keloid scars are less common in lighter skin types and in this location. However, no procedure is risk-free, and individual healing can vary.

Other Options:

Microneedling and dermal fillers can also be considered for atrophic scars, sometimes in combination with laser treatments.
Topical treatments and silicone gels/sheets may help with scar maturation but are less effective for established atrophic scars.
Summary:
For a small, atrophic scar on the cheek, non-surgical options like fractional laser resurfacing or microneedling are typically preferred as they carry less risk and downtime. Excision is usually reserved for scars that are wide, irregular, or have not responded to less invasive treatments. The risk of a new, worse scar after excision is low but not zero.

A consultation with a board-certified dermatologist or facial plastic surgeon can help tailor the best approach for your specific scar and cosmetic goals.

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