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

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.

 

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

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.