Can I get a scar revision to reduce the appearance of this scar? (Photo)

Question

I was assaulted many years ago which left a straight scar on my left cheek. After a few years my doctor recommended I have a z plasty to reduce the appearance of my scar. Z plasty performed and I was devastated with the results. The scar was noticeably bigger and 5 years later hasn’t softened and it very much noticeable. Before I go back to the doctor I would love some advice on what can be done to help reduce the appearance. Thanks in advance

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

I am hardly surprised by the lack of success with the prior scar revision surgery, since surgeries performed in areas, such as the cheek, subject to a great deal of movement have a significant risk for the subsequent development of stretch scars and even tram track stitch marks. Sorry. 
From the photos, there appears to be significant indentation of the scars. Subcision, which I have been performing since 1995, works well for elevating and smoothing indented scars from all causes, including post-surgical scars. It also has a proven track record for both safety and efficacy in all skin types. 
Once the scar has been maximally elevated, the professionally performed, manual microneedling (no need for the added expense and risks of RF microneedling) may be used to help better blend the surface of the scars in both color and texture with the surrounding normal skin.
You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist and best of luck.

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