Scar Revision for Atrophic Scar: Where to Start? (photo)

Before excising, I would suggest a series of subcision treatments. Subcision is a simple procedure that uses a needle-like cutting device that is slipped under the scar (under local anesthetic) and moved from side to side in order to break up the fibrous bands of scar tissue. This allows for the surface of the scar to float to the surface and also to promote new, more normal collagen synthesis to fill the potential space created. The result--a much more shallow scar and often significant visual improvement. A decided benefit to this approach is that the results are permanent, since the technique, as was pointed out, is predicated upon the person's own ability to produce new collagen in response to treatment.

When there is an unsightly surface texture to the scar, a series of medical microneedling treatments can be initiated. For relatively small scars, the DermaStamp can be used. This is a small instrument with a series of sterilized needles attached, which may be used, under local anesthesia, to disrupt the surface of the scar, allowing it to reform in a more uniform texture and sometimes color.

Alternatively, the Punctuated Phenol Peel technique may be used. With this technique, also performed as a series of treatments, microdroplets of full strength phenol are placed along the scar--leaving intervening untreated spaces (a fractionated approach) from which healing may take more rapidly and with less risk for actually causing a scar.

Most often, I have found that subcision performed alone or combined with medical microneedling is capable of producing quite a gratifying aesthetic improvement.

Finally, some immediate overall improvement and smoothing of the scar might be achieved with the use of a volumizing filler, such as Radiesse or Radiesse combined with Voluma (not yet available in the U.S., although soon to be) injected immediately under the scar to diminish some of that sunken appearance. 

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 been 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 laser 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 acne 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

I agree with Dr. Echavez in that you will likely see improvement in the color and texture over the first 12 months following the dermabrasion. I doubt that this will be satisfactory though. Serial excision would likely be very effective to totally excise this scar while creating the shortest possible resulting surgical scar. This would essentially result in removing the entire area with 2-3 procedures performed over time. A single excision of this area would require a surgical incision 2 1/2 - 3 times the length of the scar being removed. Serial excision would significantly reduce this. I hope this information is helpful.Stephen Weber MD, FACSWeber Facial Plastic Surgery