Acne scar, tip of nose, over two years - I have tried Juvederm and profractional laser. What other options will help? (Photos)

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

For thirty years, I have personally been performing subcision for elevating and smoothing all kinds of Indented scars, whether from acne, chickenpox, surgery, or trauma, with very gratifying results
As you have unfortunately have already learned the hard way, unlike all the expensive, bells and whistles, light and energy-based gizmos out there (whose supposed benefits are backed up far more by heavy marketing hype and social media buzz than hard science), simple and relatively inexpensive subcision has a long and proven track record for both safety and efficacy and for yielding long-term to permanent results. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment expert and best of luck.

Thank you for sharing your experience—scars on the nose can be especially challenging to treat due to the thicker skin, sebaceous nature, and limited subcutaneous tissue in this area. Since you have already tried dermal filler (Juvederm) and multiple profractional laser sessions with limited improvement, other procedural approaches may be considered:

Subcision: This involves releasing tethered scar tissue beneath the depression. On the nose, it can be technically more difficult due to limited skin mobility, but in select cases it may provide improvement.

Excision and closure: For well-defined, deep scars, a small surgical excision with precise closure can replace the depressed area with a fine-line scar that may be less noticeable.

Punch grafting or punch excision: Particularly useful for small, resistant scars, where the scarred tissue is removed and either closed or replaced with a tiny skin graft.

Cartilage or dermal grafting: For more pronounced depressions, tissue support from a graft can help elevate and smooth the surface.

Combination approach: Often, best results come from combining surgical revision with resurfacing (laser, microneedling, or dermabrasion) after healing.

It’s important to understand that while significant improvement is possible, achieving a perfectly smooth nasal contour can be very difficult due to the nature of nasal skin. That said, surgical options such as excision or grafting may offer more improvement than fillers or repeated lasers alone.