What are the options for a big indentation from a surgery? (Photo)

Question

I had an infected hair follicle on my face and a dermatologist surgically removed it which lead to infection and left epidermoid cyst so he did another surgery to remove it which also lead to infection and another epidermoid cyst. The cyst got so much smaller but left an inch wide dimple which looks a lot worse when I smile. It’s been 8 months after the second surgery . iIs my skin still trying to heal?

Nelson Lee Novick, MD · Answer

I'm really sorry that this has happened to you. From the description it would seem that the original issue was an infected sebaceous cyst. I have been cautioning my regular readers for years about the risk of scarring from all kinds of surgical excisions of the face, especially in those areas, such as the cheeks, that are subject to a great deal of muscular tension or movement. A small incision procedure (small enough that requires no placement of sutures) is my preferred method for treating a sebaceous cyst in which the cyst is teased out and removed through a small opening in the skin that allows not only for the complete removal of the cyst, but does not require suturing and the subsequent risk for development indentations or stretch scars and stitch tracks. 
Subcision, which I have been performing for over thirty years, has proven both safe and effective for elevating and smoothing all kinds of scars, including those, such as yours, from surgery. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist and best of luck. .

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your detailed history and the photo—it really helps to understand the situation. What you’re describing—a noticeable indentation after multiple surgeries complicated by infections and cysts—is unfortunately a common result when deeper tissue is removed or scar tissue forms.

At 8 months post-surgery, your skin is still in the remodeling phase. Scar tissue continues to mature and soften for up to 12–18 months after an injury or surgery, so some improvement may still occur naturally. That said, large indentations that are very noticeable when you smile often require additional treatments to improve contour.

Options typically include:

Dermal fillers (hyaluronic acid or poly-L-lactic acid like Sculptra): Can temporarily fill the depression and improve appearance. Multiple sessions may be needed for optimal results.

Fat grafting (autologous fat transfer): Uses your own fat to restore volume; more long-lasting than filler, but surgical.

Subcision or scar revision techniques: Loosens tethered scar tissue and allows the skin to lift; sometimes combined with filler for best effect.

Laser or microneedling with PRP: Helps improve skin texture and subtle volume in some cases, though it may not fully fill a deep indentation.

The best approach depends on the depth of the indentation, the quality of surrounding skin, and how natural you want the result to look. Since your dimple worsens when smiling, a combination of techniques is often most effective, with filler or fat providing volume and subcision addressing tethering.

In short, your skin may still improve slightly on its own, but significant contour correction will likely require targeted treatment. Patience is key, but there are safe and effective options to restore a smoother appearance.

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

What are the options for a big indentation from a surgery? (Photo)

Answers (3)

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