How would you treat my scar? Started off as a cyst & looks like 2 small holes (Photo)

Hello, and thank you for your question. Treating persistent acne scars, especially those that started as sebaceous cysts, can be challenging, but there are several options that might help improve their appearance:

Laser Resurfacing: Fractional CO2 laser or erbium laser resurfacing can help improve the texture of the skin by promoting collagen production and reducing the appearance of scars.

Subcision: This minor surgical procedure involves inserting a needle under the skin to break up the fibrous tissue that is pulling the scar down, which can help to elevate the depressed areas.

Dermal Fillers: Injectable fillers can be used to elevate depressed scars, making them less noticeable. Hyaluronic acid fillers are commonly used for this purpose.

Punch Excision or Punch Grafting: For deeper scars, a punch excision can remove the scar tissue, and the wound can be closed with stitches or a skin graft can be used to fill in the defect.

Chemical Peels: Medium to deep chemical peels can help to resurface the skin and improve the appearance of shallow scars.

Silicone Gel Sheets or Topical Treatments: These can help to flatten and soften scars over time, although they may be less effective for deeper scars.

Since you've already tried microneedling with limited success, a combination of the above treatments might be more effective. It’s important to consult with a board-certified dermatologist who can evaluate your specific scar and recommend the most appropriate treatment plan.

Warm regards,

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

I'm sorry that this has happened. TCA CROSS, which is used to treat ice pick acne scars, dilated pores, and even piercing holes, may prove useful for treating the small hole scars seen in the photo. Punching them out or surgically removing them runs the risk for the subsequent development of stretch scars and even tram track stitch marks. Microneedling, as you have already found out the hard way, was very unlikely to achieve much of anything, as it is best reserved for treating very superficial, surface color and texture irregularities.It's not good for deep scars. Sorry. You would be wise to make sure to consult with a board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck going forward.