Knee and elbow scar treatment options? (Photo)

Question

I have some 18 yr old scars on my knees and elbows and they are mainly lightened. When I went to a dermatologist once, they said they are mostly atrophic scars and I went to a med spa a day ago and they recommended a either a CO2 laser or plasma laser, using Kenalog in addition to either of those two. Based on my skin tone and scars, should I potentially ask for another laser or see another doctor for treatment? I do not keloid but I sometimes darken.

Jeff Rapaport, MD · Answer

You have raised scars on the knee. The simplest and least risky treatment would be injection of 5 Fuorouracil and pressure dressings. Steroids could hypopigment your skin. Multiple treatments are necessary. If this is not effective enough, adding an ablative erbium laser will flatten the lesions with the least possible side effects. This needs to be combined with bleaching cream to prevent hyperpigmentation. Find a scar expert.
Jeff Rapaport MD FAAD 
Realself Hall of Fame

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

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