I had a failed punch excision and want scar removal - will PRP injections help? (photos)

Question

I'm a 24 year old woman and my face means a lot to me. I went to fix a couple acne scars and the punch excision made it worse. I was wondering if anyone believes scar removal would help? My main concern is loss of collagen from the procedure. The left is after, right is before. Slightly diff lighting angels to show shadows. I'm also considering no scar removal and doing subsucion and filler but I'm nervous of donuting and so is the new doctor. Feeling like I made a huge mistake..

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

Jason Emer, MD · Answer

It's difficult to determine the best solution for you without the benefit of a formal evaluation. Generally speaking, scars can be improved with a combination of surgery and/or lasers and microneedling with PRP. Below is a more detailed reference list of the treatments available. I recommend getting a formal evaluation with a scarring expert to determine which is best for your specific case. 
Options can include:
1. Vascular lasers (BBL, Yellow laser, V-Beam, Excel V) 
2. Fractional lasers (Fraxel, Erbium, CO2, Halo) 
3. Microneedling/PRP 
4. Silicone-based scar gels with growth factors 
5. Excision/revision surgery 
See an expert to develop a treatment plan that works for you. Best, Dr. Emer​

Nelson Lee Novick, MD · Answer

Sorry, you have experienced this. For years I have been cautioning readers about the problem with surgical scar revisions (and punch excisions), especially in areas subject to tension or movement. The results of these kinds of revisions so often give rise to stretch scars and tram track stitch marks. From the photos, it would appear that subcision would be a reasonable option for elevating the depressed portions of the scar to be followed by Dermastamp microneedling of the area in order to better blend the treated areas in both color and texture with the surrounding normal skin. I am not suggesting subcising the more elevated areas of the scars, only those areas that are indented (depressed).  I have been performing subcision since 1994 ; it is has a proven safety and efficacy track record with very gratifying results in all skin types. Unfortunately, PRP, which is a relatively expensive approach, to date,  lacks the hard science to support the intense marketing claims for its use. Make sure that you are consulting with a board certified cosmetic dermatologist with experience and expertise in scar treatments.

I had a failed punch excision and want scar removal - will PRP injections help? (photos)

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I had a failed punch excision and want scar removal - will PRP injections help? (photos)

Answers (3)

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Recommended reading

Everything you need to know about Scar Removal

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