Can filler be used for an indented scar from laparoscopic surgery? (Photo)

Question

I developed a small scar adhesion after laparoscopic surgery, the scar was stuck down, creating a dimple. We tried subcision but it did not work. So I then had revision surgery which left a bigger scar but at least the scar is no longer tethered. To release the scar, though, the surgeon had to cut out scar tissue, which has now left an indentation. I am wondering if we can use filler to smoothe out the indentation, or whether only fat transfer will work? My injector is saying that filler in the abdomen will just "fall down" / migrate under the skin as there are no underlying structures to hold it, but I have seen people getting abdominal filler, and filler for indented scars on the body, and these fillers have not migrated. So - filler or fat transfer? The indentations are small but the larger one is driving me insane - it's literally destroyed my body image. I don't mind the small incision marks, but the indentations are really upsetting me. I would be grateful for any input, thank you!

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

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

I'm really sorry that this has happened to you, but not surprised. I frequently caution my readers on Realself that revision surgery for scars, especially in certain locations, runs the risk for the development of stretch scars and even stitch tracks. 
Regarding subcision, which is an excellent method for elevating and smoothing all kinds of indented scars in all locations and from all causes, including post-surgery, it is important to know that it may require between two to six treatment sessions (usually between three and four) to achieve a sixty to eighty percent overall improvement in appearance. I have been performing subcisions for over thirty years with gratifying results. It is important to note that only a very few "lottery winners" get their sixty to eighty percent improvement after just one treatment session. As to fillers, yes, a filler can be used, and is often used along with subcision. 
As a rule, I do not recommend permanent fillers, as permanent fillers can translate into permanent complications that may occur immediately after treatment, or even five, ten or twenty+ years later. 
You would be wise to make sure to consult with a board certified cosmetic dermatologist subcision expert and best of luck.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your photo and detailed history. I completely understand how frustrating indented scars can be, especially when they affect your body image.

Assessment:

The indentations you’re describing are post-surgical atrophic scars after laparoscopic revision.

Since subcision didn’t help and the scar tissue was excised, the resulting depression is now mostly a volume deficit rather than tethering.

Treatment Options:

1. Dermal Fillers:

Yes, fillers can be used to smooth small indented scars in the abdomen.

Hyaluronic acid fillers are temporary but generally effective for small depressions.

Migration is a concern in areas with loose tissue or minimal structural support, but careful placement in a deep, precise plane can minimize this risk.

Ideal for small-to-moderate indentations.

2. Fat Transfer:

Fat grafting is a more durable option and can treat slightly larger depressions.

Provides longer-lasting volume and can integrate with surrounding tissue over time.

Requires a minor procedure with some downtime and variability in fat survival, but excellent for abdominal scars.

Practical Considerations:

For small scars, filler is a reasonable first step to see improvement.

For larger or deeper depressions, or if filler results are unsatisfactory, fat transfer is likely the best long-term solution.

Both procedures have minimal risk when performed carefully: bruising, swelling, rare infection.

Summary:

Your smaller scars may do well with filler.

The larger indentation, which impacts your body image the most, may benefit more from fat transfer for a natural and durable result.

Starting with filler can also help gauge how much volume correction is needed before considering fat transfer.

You’re not alone—these scars can be addressed, and with the right approach, significant improvement is achievable.

Can filler be used for an indented scar from laparoscopic surgery? (Photo)

Answers (3)

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