What treatment for boxcar rolling like scar in middle of forehead? (photos)

Question

44 years of age. Light skin. Dermatological procedure using dry ice has created indented scar. Have been told subsicion and filler not good option rather fraxal laser to generate more collagen. Also thinking of surgery to cut out scar and surture to wrinkle line. So uncertain what route to go.

Nelson Lee Novick, MD · Answer

Subcision, to elevate and smooth indented scars works precisely by breaking the tethering scar collagen bonds that keep the scar indented AND by stimulating new native collagen and elastic fiber synthesis to ensure a long-lasting to permanent improvement. I have personally been performing this since 1994, and subcision has a several decades' long track record for both safety in all skin types and efficacy. Scar revision surgery, on the other hand, in areas of static muscular tension or movement, such as the glabella region often results in the development of stretch scars and tram track stitch marks. The use of bells and whistles, like fraxel lasers (as well as so many other expensive and faddish energy-based devices) unfortunately has a whole lot more marketing hype to promote its use than any hard science to support it. So, exercise a weighty amount of "beware beware" when evaluating these kinds of treatments.

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Kristine Brecht, MD (license suspended) · Answer

Dear realselfme,
Facial scarring can be very challenging to get rid off, rather we have treatments that can help blend scarring and minimize the appearance.
A multi factorial approach over multiple treatments over time is the norm.
Microneedling with prp, subcision, Botox and fillers would all be of benefit in combination.
Best. DrBrecht 
Seattle, Wa

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