Best methods for scar removal? I have scars from bunion surgery on my foot (Photo)

Question

I have scars from bunion surgery on my foot. I started laser treatment, injections and lightening treatment. I am concerned it may not produce a dramatic result. Would I be a good candidate for dermbrasion or any other effective scar removal methods?

Nelson Lee Novick, MD · Answer

It is difficult to fully assess from the photo, but it appears that there is a central hypertropic (elevated, "proud flesh") scar running down the center surrounded by an area of irregular pigmentation and "tram track" stitch scars to the sides. If this is so, then the use of intralesional anti-inflammatory injections can flatten the hypertrophic scar after which a series of microneedling treatments accompanied by the application of prescription pigment enhancer, such as topical tyrosine and lanatoprost, can help to repigment the surrounding skin and improve the appearance of the stitch marks. I would be reluctant to advise surgical revision, since, particularly in areas subject to motion or tissue tension, is likely to result in a stretch scar and stitch tracks. Make sure to consult with a board certified cosmetic dermatologist and best of luck.

Jason Emer, MD · Answer

It's difficult to determine the best solution for you without the benefit of a formal evaluation. Generally speaking, scars can be improved with a combination of surgery and/or lasers and microneedling with PRP. Below is a more detailed reference list of the treatments available. I recommend getting a formal evaluation with a scarring expert to determine which is best for your specific case. 
Options can include:
1. Vascular lasers (BBL, Yellow laser, V-Beam, Excel V) 
2. Fractional lasers (Fraxel, Erbium, CO2, Halo) 
3. Microneedling/PRP 
4. Silicone-based scar gels with growth factors 
5. Excision/revision surgery 
See an expert to develop a treatment plan that works for you. Best, Dr. Emer​

Daniel Barrett, MD · Answer

Dear leandra23,
it is hard to tell for sure without an examination. Based on your photo, it looks like you would benefit from scar revision. If you are considering surgery, I would suggest you consult a board-certified plastic surgeon. Only after a thorough examination, you will get more information and recommendations.
Daniel Barrett, MD
Certified, American Board of Plastic Surgery
Member, American Society of Plastic Surgery
Member, American Society of Aesthetic Plastic Surgery

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