How to treat this a dip depress scar?

Question

I had scar revision 13 months ago , and the scar not very even , kind of dip there . Any treatment can improve this scar or need to do another scar revision cut ?

Anna Chacon, MD, FAAD · Answer

Hello, and thank you for your question. I'm sorry to hear that you're dealing with this issue. There are several options for treating a depressed scar, and the best approach depends on the specific characteristics of your scar and your overall skin condition. Here are some potential treatments to consider:

Dermal Fillers: Injectable fillers, such as hyaluronic acid, can be used to elevate the depressed area and make the scar less noticeable. This is a relatively quick procedure with minimal downtime, but the results are temporary and typically last several months to a year.

Microneedling: Also known as collagen induction therapy, microneedling involves using fine needles to create micro-injuries in the skin, which stimulates collagen production and can help to improve the texture and appearance of scars over time.

Laser Resurfacing: Fractional laser treatments, such as CO2 or Erbium lasers, can help to smooth out the skin surface and improve the appearance of depressed scars. Multiple sessions may be required for optimal results.

Subcision: This is a minor surgical procedure where a needle is inserted under the scar to break up the fibrous tissue causing the depression. This can help to release the scar and allow it to elevate to the level of the surrounding skin.

Steroid Injections: If the scar is raised in some areas and depressed in others, steroid injections can help to flatten the raised portions, making the overall appearance more even.

Scar Revision Surgery: If non-surgical treatments are not effective, a secondary scar revision surgery may be considered. This involves excising the old scar and carefully suturing the skin to create a more aesthetically pleasing result.

Topical Treatments: Silicone gel sheets or silicone-based creams can help to improve the appearance of scars over time. These treatments are most effective when used consistently over several months.

It’s important to consult with a board-certified dermatologist or plastic surgeon who specializes in scar treatment. They can assess your scar in person and recommend the most appropriate treatment based on its characteristics and your individual needs.

Warm regards,

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

Nelson Lee Novick, MD · Answer

Before jumping into another expensive surgery, with its potential risks for infection, scarring, stretch scars, stitch track formation and prolonged downtime, you may wish to consider consulting with a board certified cosmetic dermatologist scar treatment specialist regarding the use of subcision. Subicision, which is a minimally invasive technique that requires no surface scalpel cutting and which I have personally been performing since 1995, has a long track record of safety and efficacy for elevating and smoothing all kinds of skin indentations and indented scars. Hope this helps and best of luck.

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