Options to get rid of bad alarplasty scar? (Photo)

Question

Any advice on how to fix/heal my alarplasty scar? I’m about 4 months post op in this photo, and going on 5 months now. I believe it’s a keloid scar. I didn’t use scar gel for a while until very recently because the cut was still open and painful. Should I continue to only use scar gel before addressing the scar with other methods, or should I look into alternative ways now? Would CO2 laser be helpful?

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Back in the late 1980s already, scar treatment specialists already knew that there was an ideal window for treating imminent scars (between 4-12 weeks following surgeries, trauma, infections, acne, etc. So, this case is a bit beyond that critical window, so rather than wasting time and money on if-fy treatments, like scar gels and sheeting, it would be wise to consult a board certified cosmetic dermatologist scar treatment specialist. It is a bit difficult to tell from the photo provided, but if there are small bumps of hypertrophic scar tissue, these can be flattened with tiny boluses of an intralesional anti-inflammatory agent. Once flattened, then Dermastamp microneedling (no need for additional RF, which poses an additional risk for causing potentially persistent pigmentary issues) can be performed to help the scar blend better with the surrounding normal skin. CO2 laser, much like dermabrasion is an aggressive procedure that runs a significant risk for itself causing scars and for dyspigmentation (either hyperpigmentation or hypopigmentation, which can be especially problematic in skin of color. You would be wise to promptly consult a scar specialist cosmetic dermatologist. Hope this helps. Best of luck.

Jeff Rapaport, MD · Answer

In my opinion, Your 5 month old scar should respond to a Fractionated CO2 laser. I would pretreat with 5FU and bleaching cream. One or two sessions are needed. Find a scar expert. 
Jeff Rapaport MD FAAD 
Realself Hall of Fame

Viktoryia Kazlouskaya, MD · Answer

A few options are available to treat this scar. I would recommend a combination of microneedling and erbium laser. Microneedling will help restore collagen in the scar from beneath, and erbium laser will resurface the surface. Erbium laser is similar to CO2 but is safer for skin of color. Additionally, Kenalog (triamcinolone) can be used after the procedure to soften the scar. You may need 1-3 rounds of treatments to improve the appearance of the scar. Feel free to contact us for a quote. We would be happy to help you.

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