Which procedure would minimize the appearance of a scar on my nose from cystic acne? 26 y/o male (photos)

Question

8 months ago I developed a huge cystic pimple on my nose and since I have a red raised acne scar on my nose. My derm prescribed tretinoin and benzoyl peroxide - they reduced the overall amount of acne on my face, but did not help the scar. Next he prescribed a steroid cream (fluticasone) for the scar, however it hasn't helped either. My derm doesn't specialize in cosmetics so he suggested looking elsewhere now. How can I get this fixed? Laser? Microneedle? Fraxel? 26 male

Nelson Lee Novick, MD · Answer

At least from the history and the one photo, the scar is likely to be a small hypertrophic acne scar. If this is indeed the case, then the use of an intralesional injection of an anti-inflammatory agent would likely flatten this small scar quite quickly. You would be wise to consult with a board certified cosmetic dermatolgist scar treatment specialist and best of luck.  i

Anna Chacon, MD, FAAD · Answer

For a red, raised acne scar on the nose that's persisted for 8 months, several cosmetic dermatology treatments may be more effective than topical medications alone. Since topical tretinoin, benzoyl peroxide, and steroid cream haven’t resolved the issue, it’s reasonable to explore procedural options.

1. Vascular Laser (e.g., Pulsed Dye Laser or IPL)
Purpose: Targets redness by reducing excess blood vessels in the scar tissue.

Best For: Persistent red or pink coloration in scars (post-inflammatory erythema).

Expected Outcome: Gradual fading of redness over a few sessions.

Downtime: Minimal.

2. Fractional Laser (e.g., Fraxel or CO₂ Laser)
Purpose: Improves texture and thickness of raised scars by resurfacing the skin.

Best For: Thickened or uneven surface, in addition to discoloration.

Expected Outcome: Smoother, flatter appearance with reduction in scar visibility.

Downtime: Moderate (2–7 days depending on laser strength).

3. Microneedling (With or Without RF)
Purpose: Stimulates collagen remodeling, which can soften raised scars and improve texture.

Best For: Mild to moderately raised or uneven scars.

Expected Outcome: Gradual smoothing over multiple sessions.

Downtime: Mild redness for 1–2 days.

4. Intralesional Steroid Injections
Purpose: Direct injection of corticosteroids to flatten raised (hypertrophic) scars.

Best For: Firm, raised scars (keloids or hypertrophic scars).

Expected Outcome: Noticeable flattening within weeks.

Note: May be more effective than steroid cream when the scar is thick.

Treatment Plan Recommendation:
If redness is dominant → start with vascular laser (PDL or IPL).

If scar is raised and firm → consider intralesional steroid injections.

If texture is uneven → consider fractional laser or microneedling.

Conclusion:
Since topical treatments haven’t improved the scar, combining vascular laser for redness and resurfacing (laser or microneedling) for texture is the most targeted approach. A cosmetic dermatologist or laser specialist can tailor the right sequence based on the scar’s characteristics.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 acne 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

Which procedure would minimize the appearance of a scar on my nose from cystic acne? 26 y/o male (photos)

Answers (3)

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