Scar revision vs laser scar removal? (Photo)

Question

2cm scar post nevus excision 10 years ago. Scar is quite shiny and of cosmetic concern. Recent consult for scar revision surgery but cancelled as concerned for risk of worsening outcome or longer scar. Any advice would be highly appreciated. Would you consider laser at all? Thank you

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

There is legitimate concern that scar revision in areas subject to motion may lead to the development of of unsightly stretch scars and tram track stitch marks. Likewise legitimate is the concern that fraxel lasers may not be effective, since the hard science to support the use of these expensive "bells and whistles" gizmos lags woefully behind the heavy marketing and social media hype to promote them. And CO2 laser treatment, much like old style dermabrasion, is an aggresive abrasive procedure that is not only relatively expensive, but typically engenders prolonged post-procedure downtime and runs the risk of scarring and prolonged, persistent dyspigmentation problems. Consider instead two relatively inexpensive approaches, specifically subcision to elevate and smooth the indented component of the scar and professionally performed, manual microneedling (no need for the expense or risks of added RF) to blend the surface color and texture of the scar better with the surrounding normal skin. You would be wise to consult a board certified cosmetic dermatologist and best of luck.

Scar revision vs laser scar removal? (Photo)

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Scar revision vs laser scar removal? (Photo)

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Our mission is to create a world where every investment in modern beauty is Worth It.