Improving scar pigment and texture? (Photo)

Question

I’ve had a dermatofibroma removed an over 2 years ago when I was 30. Had wound dehiscence after removal of stitches. Fast tracked to now, the scar is much bigger than what was anticipated. Can laser or other methods ie creams etc be used to improve the texture or lighten the overall scar to be more uniformed?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. 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 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 scars and indented  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 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 lasers 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 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

Nelson Lee Novick, MD · Answer

First, I am sorry that this has happened to you. To avoid the kinds of complications you had, I generally suggest removing dermatofibromas by a simple technique known as Scalpel Sculpting, which is also used for removing all kind of elevated (as well as flat) moles, since it does not involve deep cutting or the use of stitches. From the photo, the scar appears elevated as well as hyperpigmented. If so, then the use of intralesional anti-inflammatory injections can help not only to flatten the scar, but likely promote its lightening in color. Once flatter, professionally performed manual microneedling (no need for the added expense and risks of RF microneedling) can be performed to better blend in both color and texture the area with the surrounding normal skin (although generally speaking, this is often not required following the aforementioned injejctions). You would be wise to consult with a board certified cosmetic dermatologist. Best of luck, and Happy New Year.

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