Ten year old neck scar puckering - how can I help this? (Photos)

Question

Hello I had a procedure 10 years ago for skin under my neck after weight loss which resulted in a Z scar. Recently I had a deep plane face & neck lift. The scar for the neck lift is small and perfect but the old scar is puckering (see pics). What can I do to help this.

Anna Chacon, MD, FAAD · Answer

Hi there—thank you for sharing your history so clearly. It sounds like you’ve already gone through a lot with your procedures, and I can understand how frustrating it must be to have an older scar now standing out, especially after a beautifully healed recent neck lift.

Why this older scar is puckering

What you’re seeing is actually quite common with older scars, especially in areas like the neck where the skin is constantly moving.

A few things may be contributing:

Scar tethering: the deeper part of the scar is likely attached to underlying tissue, creating that “pulled” or puckered look

Changes from your recent surgery: tightening from the neck lift can make older scars more noticeable

Loss of elasticity over time, which can exaggerate contour irregularities

So even though the scar is 10 years old, the surrounding tissue has changed—and that can make it behave differently now.

Non-surgical options to improve it

There are several effective treatments that can soften and smooth the appearance:

1. Steroid injections

Help flatten thickened or raised areas

Can reduce tension within the scar

2. Microneedling or RF microneedling

Stimulates collagen remodeling

Helps improve texture and blending with surrounding skin

3. Laser treatments

Can improve both texture and color mismatch

Particularly helpful if the scar looks uneven or slightly raised

4. Subcision (very helpful for puckering)

A small procedure that releases the scar from deeper attachments

This is often one of the most effective treatments for tethered scars like yours

When surgery might be considered

If the puckering is more pronounced or resistant to the treatments above, a scar revision procedure can:

Release the tethering

Re-close the area in a way that heals more smoothly

The good news is that your recent neck lift healing well suggests your skin has a strong ability to heal nicely, which is a positive sign if revision is ever needed.

What I’d recommend thinking about

Given your description, I would strongly consider starting with:

Subcision (to release the pull)

Possibly combined with laser or microneedling for texture refinement

These approaches are less invasive and can make a meaningful difference.

A reassuring note

You’re not “stuck” with this. Even though the scar is old, scars are very responsive to treatment—even years later. With the right approach, we can usually achieve a much smoother, more natural contour so it blends better with the rest of your neck.

You’ve already come a long way with your results, and this is something that can absolutely be improved further.

Ten year old neck scar puckering - how can I help this? (Photos)

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