Options to improve old philtrum scar under nose? Scar revision vs laser/microneedling?

Question

I’m looking for advice on how to improve an old scar located in the philtrum area, directly under my nose and above the upper lip. The scar is many years old and fully healed. It is a small vertical scar, but what bothers me is that it seems slightly tethered/indented and creates some puckering rather than just looking like a flat line. It does not seem like a keloid. It is not painful, but it can feel a little tight at times. My main goal is to make it less noticeable and improve the contour so the area looks smoother and more natural. I’m trying to understand what treatment would likely give the best result in this area. A few questions: 1. Does this look more like a tethered/indented scar versus a raised scar? 2. Would scar revision surgery likely work better than laser or microneedling for this type of scar? 3. If surgery is recommended, is improvement usually meaningful for a scar in this location? 4. Are there risks of making the scar more noticeable in the philtrum/upper lip area? 5. Would you recommend seeing a facial plastic surgeon or a dermatologist who specializes in scar treatment? I’d appreciate any guidance on the best option for this type of scar and what kind of improvement is realistic. Thank you.

Anna Chacon, MD, FAAD · Answer

Thank you for sharing such detailed information and your photos. From your description, it sounds like your scar is more tethered/indented rather than raised, which explains the subtle puckering you notice. This type of scar can create a small depression or pull on the surrounding tissue, even many years after it has healed.

Here’s a breakdown of your questions and the typical approach:

Tethered/Indented vs Raised Scar:
Based on your description (vertical, small, slightly puckered, not keloid), this appears to be a tethered/indented scar. Raised scars usually look more elevated or thickened, which doesn’t seem to be the case here.

Scar Revision Surgery vs Laser/Microneedling:

Scar revision (surgical excision or release): This is often the most effective option for a tethered or indented scar, especially in the philtrum, because it allows the tissue to be released and realigned. When done carefully with fine suturing, the improvement can be very meaningful, smoothing the contour and reducing the puckering.

Laser or microneedling: These treatments primarily improve surface texture and pigmentation. They can soften the scar and make it blend better with the surrounding skin, but they usually cannot fully release a tethered scar.

Expected Improvement from Surgery:
In experienced hands, surgical revision in the philtrum area can provide a noticeable improvement in contour and smoothness. Because the philtrum is such a central and delicate part of the face, even subtle refinements can make a visible difference.

Risks of Surgery:
The main concern is that the philtrum/upper lip is a very visible area. If not done carefully, a new scar could be slightly more noticeable, so it’s crucial that the technique is precise, with meticulous alignment of the natural lip contours. That’s why fine suturing and post-procedure scar care are essential.

Whom to See:
Both facial plastic surgeons and dermatologists specializing in scar treatments can provide excellent care. A facial plastic surgeon may be preferred for surgical release of tethered scars, while a dermatologist can be excellent for laser, microneedling, or combined approaches. Sometimes a combination—surgery for release followed by laser or microneedling for texture—gives the best result.

Summary:
For your type of scar, surgical revision is likely to give the most meaningful improvement in contour and puckering. Laser or microneedling can be considered as an adjunct to refine texture afterward. The key is to work with someone experienced in philtrum/upper lip scars to minimize the risk of a more noticeable scar.

Even though perfection isn’t guaranteed, with careful technique, a smoother and more natural-looking philtrum is very achievable.

Options to improve old philtrum scar under nose? Scar revision vs laser/microneedling?

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