Best treatment for recessed scar on nose left from cold sore? (photos)

Question

About 5 months ago I had my first and only ever serious outbreak of cold sores on my mouth. Around the time they were developing, I had decided to pick at the pores on my nose and accidentally broke the skin (which I had never done and was quite surprised). This must have spread the virus, because within days I had a cluster of sores on my nose where the skin was broken. After they healed, I was left with this scar. Any idea what is the best treatment? Also for the enlarged pores?

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

Nelson Lee Novick, MD · Answer

Subcision, which breaks up the tethering scar tissue below that is pulling the base of the scar downward, is a simple, tried and true technique for elevating all kinds of depressed scars--whether from trauma, surgery, acne or, as in this case, infection. The addition of a biostimulatory filler, such as Radiesse, injected below the scar--either at the time of subcision or at a subsequent treatment session--can provide not only immediate improvement, but further promote new, native collagen synthesis (neocollagenesis). Finally, any remaining surface irregularity (and the enlarged pores on the rest of the nose) can be additionally improved via fractional microneedle resurfacing (aka medical microneedling, skin needling, dermal rolling, or needle dermabrasion). For more information on any of these topics, check out the archives of Realself.com, and, it should go without saying, seek consultation and treatment by a board certified aesthetic physician with extensive experience and expertise in scar treatment and make sure to ask to see his/her befores and afters. Finally, a word of caution. Be wary of expensive laser treatments, especially nonablative fraxels that may sound enticing. In my experience, they have proven disappointing and far more device manufacturer supported hype than hard science. In the December, 2014  issue of one of our trade journals, Seminars In Cutaneous Medicine & Surgery, regarding lasers in acne scarring, the author wrote, "The downside to utilizing nonablative interventions is the more modest and perhaps, unpredictable results."

Darryl J. Blinski, MD · Answer

Difficult issue. Might try micro needling with fat grafting to elevate and smooth the dented scar.....

Best treatment for recessed scar on nose left from cold sore? (photos)

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