can be done to flatten and smooth the appearance of scarring after permanent makeup removal on the lip border? (photos)

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

Scarring after permanent makeup removal, particularly with methods such as Rejuvi, can sometimes result in textural irregularities, discoloration, and firmness along the lip border. The goal of treatment is to improve smoothness, reduce scar visibility, and restore a more natural contour.

Several approaches may be considered:

Laser resurfacing (fractional CO₂ or erbium laser): Helps smooth raised or indented scars, stimulate collagen remodeling, and improve pigmentation.

Microneedling or RF microneedling: Can soften scar tissue and gradually improve texture over multiple sessions.

Steroid or 5-FU injections: May help flatten raised or firm scar tissue if there is hypertrophy.

Chemical peels: Mild to moderate peels can help improve pigmentation irregularities but may need to be combined with other treatments for texture changes.

Topical treatments: Medical-grade silicone gels, retinoids, or lightening agents can assist with discoloration and scar softening.

Camouflage tattooing (paramedical micropigmentation): Once the scar is stable, some patients benefit from blending the color difference with specialized tattooing techniques.

A combination approach is often the most effective, depending on whether the main issue is raised tissue, indentation, or pigment change. Improvement is gradual and multiple sessions are usually required, but significant softening and blending of the scar can typically be achieved.

thanks for interesting question. it seems to me that there is no way to remove this invisibly so its a question of trying to make as tidy as possible. my guess is that since you already have a thickened, widened and pigmented scar, there is little to be lost from doing a surgical excision and suturing it neatly and hoping that you end up with a neater, flatter scar than the one you currently have.....but there is potential that you end up with something no better than what is there now and also, if unlucky, something with a worse appearance. sorry, there is no easy or guaranteed solution here.