What do you think is best course of action for this fourteen year old scar? (Photos)

Question

I am a 21-year-old female who has had this scar for approximately 14 years as a result of a car accident when I was 7 years old. I am very interested in having it treated or removed and wanted to ask whether CO₂ fractional laser treatment would be effective, or if surgical scar revision would be the better option. My main concerns are skin discoloration and achieving an even, natural skin tone. My goal is for the scar to be as unnoticeable as possible. Preferably gone but I know that’s not entirely possible.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photo and history—it really helps to understand your goals. From what I can see, the scar is mature and linear, with some residual discoloration. At this stage, there are a few options to consider, each with its own benefits:

CO₂ fractional laser treatment: This can help improve texture and pigmentation, making the scar blend more naturally with the surrounding skin. It won’t completely remove the scar, but it can significantly soften its appearance over several sessions.

Surgical scar revision: For scars that are very thick, wide, or irregular, a skilled surgical revision can reposition or remove the old scar, often creating a thinner, straighter line. This is sometimes combined with laser or topical treatments afterward to improve color and texture.

Because your main concern is skin discoloration and achieving a natural tone, a combined approach is often the most effective: surgical revision if the scar contour is uneven, followed by laser or other light-based therapies to even out pigmentation.

It’s important to have realistic expectations—even with the best treatments, scars may never disappear entirely, but they can become much less noticeable and more natural-looking over time.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

For elevating and smoothing the Indented portion of the scar, I would consider subcision, which has a proven safety and efficacy track record of over thirty years for improving Indented scars from all causes, including post-traumatic, as in this case. 
Once the scar has achieved its maximum improvement from subcision, then manual dermarolling microneedling can be performed (no need for the added expense and risks of RF microneedling) can be performed to better blend the surface color and texture with the surrounding normal skin. 
Since the scar is a ?mature scar," I.e. over three months of age, the best improvement that can be offered is somewhere between a 60-80% overall improvement in appearance after on average three to four treatment sessions of each of the foregoing treatment modalities. 
I would be concerned about surgical revision, as, especially in areas such as this, sub ject to a great deal of muscular movement and tension, the subsequent development of a stretch scar and even stitch tracks. I would likewise be leery of laser treatment out of concern for the development of post-inflammatory dyspigmentation, especially of concern in skin of color. 
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck.

What do you think is best course of action for this fourteen year old scar? (Photos)

Answers (3)

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