Hi, I need to know the best way to treat this indented scar? (photo)

Ive tried merderma, cocoa butter, and none seem to work. This scar really makes me sad and non confident. Im tired of wearing hats to cover it up. Someone please help me Identify which type of scar it is and what I can do? This scar really makes me sad and non confident. Im tired of wearing hats to cover it up. Someone please help me Identify which type of scar it is and what I can do. Would derma roller work for it. Is it a collagen issue, where its not producing there?

Doctor Answers 5

Indented Scars Respond Well To Subcision, Fractional Medical Microneedle Therapy + Biostimulatory Filler

First, let me say that I am sorry that you are suffering with this problem.

Indented or depressed scars, whether from trauma, acne, or infections like chicken pox generally need to be addressed with several minimally invasive modalities in order to achieve a truly gratifying result. Unfortunately, topical preparations, despite the markeing hype, do little if anything, in my experience.

For the depression, I typically begin with subcision, a technique whereby a sharp needle or trochar is used to break up the the downwardly tethering scar tissue below the skin surface. The intention is to allow the scar to float upwards and become flush with the surrounding skin and to promote new, native collagen synthesis (neocollagenesis) below the base of the scar to provide permanent support. In general, two to four treatments, spaced at six week intervals, are needed for optimal correction. The results of subcision are permanent.

To provide a more immediate improvement, I also typically inject a small amount of biostimulatory filler, such as Radiesse, immediately after subcision.  This is to provide immediate support--and visual improvement-- for the base of the scar, while awaiting neocollagenesis, which can take about a month to a month and a half to occur. A biostimulatory filler is chosen to enhance and supplement the neocollagenesis.

Finally, depending upon the color and texture of the surface of the scar, a series of fractional medical microneedle treatments might be considered to help to lighten the scar and make its appearance more uniform with the surrounding normal skin.

There are no contraindications or additional considerations for using any of these techniques in people of color.

For more information on any of the above approaches, check out the archives of Realself.com. and be sure to seek out consultation and treatment by a board certified aesthetic physician with expertise and experience in scar treatments.

New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Treatment of a forehead scar

Our office specializes in scar revision in Los Angeles. Step one would be to begin a skin lightening regimen with Melarase AM and Melarase PM, followed by either scar excision or laser resurfacing of the scar. Dermabrasion is an old treatment that is seeing less and less use currently. 

Raffy Karamanoukian MD FACS

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Indented scar treatment

The gold standard for depressed, pitting and even crater-type acne, chicken pox, and similar indented scars is dermabrasion (not micro-dermabrasion) whereby the skin is sand down with a diamond tip burr to the deeper layers leaving a raw surface for about a week before new smooth skin regenerates. Note, this procedure should only be done by a trained surgeon in an operating room not a nurse nor a technician in a spa setting.
Once your wounds are healing then scar therapy may be considered. Although the results of scar therapy vary from person to person and scar to scar, the results are typically permanent.
Not infrequently potential patients avoid surgery because fear of an unsightly scar. To remedy this, I now utilize and formulate compounded topical creams to treat, relieve and minimize scars for each of my patients:
• new scars
• old scars
• surgical scars
• keloid scars
• stretch marks
• hypertrophic scars
• hyperpigmented (dark) scars
• various acne scars, burn scars and more...
These scar removal creams contain prescription strength medications each individually known to reduce and/or reverse the scarring process but never before compounded together into one high potency formulation. These medications are added to a base of anhydrous silicone (the most common ingredient in everyday topical scar therapy) and Pracaxi oil, found in the Amazon rainforest and known for its anti-inflammatory, antioxidant, antibacterial, and antifungal properties. Many health insurance plans actually cover the cost of the creams and they can be delivered directly to the patients door step. In other words, no need for multiple trips to the doctor for expensive and painful laser treatments, or wasted money on minimally effective over-the-counter topical scar therapy gels or silicone sheets that are unsightly and/or fail to stay on. Instead, with just two applications a day my patients now perform scar therapy in the comfort of their own home. Glad to help.

Ryan Stanton, MD
Beverly Hills Plastic Surgeon
4.8 out of 5 stars 117 reviews

Indented Scar Therapy

Topical products will not be of much help in your case. You have a few options:

1. Superficially placed filler, particularly Belotero
2. Normal Saline injections to life the scar
3. Microneedling therapy: you will likely need 4-6 treatments
4. Surgical Scar Revision

I would recommend using Belotero to start with and then evaluate your improvement. 

Consult with a Board-Certified Dermatologist or Plastic Surgeon. 

Jennifer Ahdout, MD, FAAD
Beverly Hills Dermatologist
5.0 out of 5 stars 18 reviews

How to treat indented scar on forehead?

I would not expect any topical treatment to help improve the indented scar on your forehead.  I'm not sure of the cause of the scar or how long you've had it, and this information could be helpful in determining your treatment options.  I would say, in general, there are a couple of ways to try and improve a depressed (indented) scar.  A filler can sometimes be injected under the scar to raise it, which can make the scar less noticeable.  The other method would be to perform a surgical scar revision to remove the scar and ideally, give you a flatter, thinner scar that would be less apparent.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.