44, female, I have extremely bad scarring on my legs, what's best option for me? (Photos)

Question

I am a 44 year old woman and I have battled a terrible substance abuse disorder for years. It has left my legs with extremely bad scars not to mention collapsed veins. What’s the best option for me?

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

Jeff Rapaport, MD · Answer

You have multiple different types of scars on your legs. Scars are treated based upon their type. All scars are hyperpigmented. Your pigment is deep. Chemical peels, bleaching cream and IPL can help. Raised scars can benefit from intralesional injection and Fractionated ablative lasers. Depressed scars need subcision, PRP and possibly filler. Multiple sessions will be needed. Find a scar expert. Good luck.
Jeff Rapaport MD FAAD 
Realself Hall of Fame

Nelson Lee Novick, MD · Answer

I am really sorry that you are having this issue and completely understand the importance both physically and psychologically for treating this often very difficult-totreat problem, which combines involves both scarring and dyspigmentation. Professionally performed manual Dermastamp microneedling accompanied by the application of prescription pigment reducing agents, as well as at-home use of these prescriptions, can address both the scars and the dyspigmentation. A series of supeficial peels using maximum concentration alpha or beta hydroxyacids, Jessner's solution or low concentrations of TCA may be additionally helpful. I would suggest the treatment of one or two sites in this way to assess progress before proceeding with more aggressively treating all of the involved areas. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Best of luck.

Michelle Copeland, MD, DMD · Answer

Thank you for your question. I would need to examine you in-person to best answer your question. In 5 to 10 percent of people, scars become hypertrophied because of an overproduction of scar tissue, and in some cases a keloid develops, causing a scar to appear dark, thickened, and raised. It used to be that to get rid of a scar, doctors had to excise it surgically and resuture the wound in such a way as to minimize its appearance. But that really meant just replacing one blemish with another one potentially just as noticed. Fortunately, today we have several ways to improve a scar's appearance. Some techniques are most effective when a scar is still fresh, such as pigment blocking creams to even out color, silicone gel to improve texture, and massage to break down the tissue. But we also have several options after a scar has fully formed. Steroids injected directly into the healed wound can help to shrink the tissue and microdermabrasion and lasers can improve the appearance of the scar. I recommend you meet with a board-certified plastic surgeon to explore your options in more detail.

44, female, I have extremely bad scarring on my legs, what's best option for me? (Photos)

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