How to Get an Old Indented Scar off my Face? (photo)

Question

Now I've had this for 6 years. And I, really, really need this gone I can't look good with it on my forehead. Please someone tell me how to remove this.

Nelson Lee Novick, MD · Answer

There are a number of methods for improving depressed (atrophic) pox-like scars. Through the years I have found the subcision, which takes only minutes to perform, to provide relatively rapid and gratifying and long-term improvement.

	Subcision, a procedure, performed under local anesthetic, that entails using a sharp needle-like device is first inserted to break up the scarred, heavily fibrotic tissue that makes up the base of the scar. Immediately following, a small amount of volumizing material is injected into the potential space just created by the prior procedure. An immediate lifting is seen and the area can be smoothed flush with the surface resulting in the immediate, gratifying improvement seen. As an added plus, six to eight weeks later, neocollagenesis (new collagen formation) occurs in response to both the subcision procedure and the presence of the volumizer--contributing to a  much longer lasting improvement. The entire procedure takes no more than five minutes to perform, requires no scalpel cutting or stitches and entails no significant downtime.

	If necessary, either immediately following the subcision, or at a subsequent treatment session, a volumizing filler, such as Radiesse can be injected directly underneath. This not only results in immediate lift and smoothing, but itself also stimulates additional new collagen synthesis four to eight weeks down the road.

	Alternatively, an entirely surgical approach, which entails some downtime, may be used. Following local anesthesiia, the scar is "punched" out, using a cookie-cutter like instrument known as a punch and then stitched together. This is then followed in eight to twelve weeks by a technique known as manual scarabrasion, in which sterilized sandpaper is essentially used to blend the edges of the wound, allowing the area to eventually heal with little evidence of scarring.

Raffy Karamanoukian, MD, FACS · Answer

Atrophic scars can improve with excision, subcision, and laser skin resurfacing. All of these procedures can improve the texture and topography of the scar. Raffy Karamanoukian Los Angeles

Brian S. Biesman, MD · Answer

There are several options for treatment of indented scars. In some situations the scars will improve with a technique referred to as subcision in which a special blade is used to release the bands of tissue that bind the back side of the skin's surface to the deeper tissue. In other cases either injectable filler or a piece of tissue taken from another part of your body (typically behind the ear or at the bikini line) can be placed in a pocket beneath the scar so as to elevate it and make it appear less depressed. If the skin quality is very poor then ablative fractional lasers can sometimes be used to remove a portion of the scar. Several such treatments are typically required. Finally, the scar can be removed entirely and the resultant defect closed. Sometimes in a scenario like this laser skin resurfacing is performed prior to closing the wound so as to improve the final appearance of the wound as it heals. The only way to determine which of these approaches is best for you is to take is to have a consultation with a surgeon who is comfortable with each of these options.

Kenneth Dembny, II, MD · Answer

There are several options available to you:

	Subcision and use of a soft tissue filler will provide improvement in the depression/indentation; but this will not remove the scar. The results will depend upon how soft the scar is and how tethered the scar is underneath. This treatment will have to be repeated at regular intervals (potentially as often as every 9-12 months).

	Fractional laser resurfacing will likely provide some improvement/blending, but will not remove the scar. It may produce a scar that is slightly smaller or not quite as deep; and it may soften the edges of the scar.

	Punch excision is a nice option depending upon the size of the scar. A circular punch is used to remove the scar and the skin edges are closed with sutures. If this can be removed with a 3mm or 4mm punch then there is good chance for significant improvement. The resulting scar would be about the same size as what you have now, and it would be linear. To reduce the risk for subsequent scar widening (when larger punch sizes are utilized), a deep suture can be placed to help support the skin closure. Trading one scar for another is a good option if the risks are low and the subsequent scar is viewed by the patient as an improvement over what was present previously.

	If the scar is larger, then surgical excision can be used. This would involve a transversely-oriented elliptical excision of skin that incorporated the scar. The skin edges are closed with at least 2 layers of sutures, producing a transverse linear scar. The scar length would be about 3-4 times the vertical dimension of your current scar. The scar would run parallel with the relaxed skin tension, lines of the forehead and should heal well.

	Consult a plastic surgeon to discuss these options further. Following an examination of the scar s/he can guide you in your decision making process.

	Best wishes. Ken Dembny

Harold J. Kaplan, MD · Answer

Hi Helpme.  You have several options.  While none of them will leave this area looking perfect, there may be improvement.  

	1.  Fractional Laser Resurfacing.  The idea is to stimulate new collagen and release hard scar tissue below the scar.  Results would be limited.

	2.  Punch excision.  This is a surgical procedure that involves removing a portion of the tissue where the scar is located.  In this case, you are treading one scar for another.  Find a plastic surgeon that does this and view photos of other patients before proceeding.

	3.  Surgical revision.  Similar to punch excision, but there would be a linear scar present after.  Again, trading one imperfection for another.  Depending on how you heal, this may be preferable for you.  

	If you do not accept having to trade a new scar for an old one, try the laser resurfacing.  Although the benefits may be limited, it will not involve trading for another scar like the other two options.

How to Get an Old Indented Scar off my Face? (photo)

Answers (5)

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