Could this old scar be removed with punch excision between philtrum? (Photos)

Question

This scar is old and got injections till they said it was to shallow to keep on.I’ve microneedled a couple times across the years and it is soft.Could it be removed with a punch hole needle once in for all?Would that further blur my plitrum columns?About how much it range in cost?I have Medicare with fildelis idk it they would cover tht.It been 7 years and I spiraled bad as it reminded me of the trauma related to it.I only look at myself normally in the mirror around the eyes and up

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Punch excision can be a viable method for removing scars, especially those that are deep or have a defined edge, such as ice pick scars or boxcar scars. However, its suitability for your specific scar depends on several factors, including the scar's depth, width, and location between the philtrum columns.

Punch excision involves using a punch biopsy instrument to remove the scar tissue, and it is often followed by suturing or grafting to close the wound[3]. This method might not be ideal if the scar is shallow or if it could potentially blur the philtrum columns further, as you mentioned.

Regarding the cost, it can vary widely depending on the location, the expertise of the practitioner, and whether it is covered by insurance. Medicare typically covers procedures deemed medically necessary, but cosmetic procedures are generally not covered unless they are part of a larger medical treatment plan.

To determine the best approach for your scar, consulting a dermatologist or plastic surgeon is recommended. They can assess the scar and provide personalized advice on whether punch excision or another method, such as fillers or laser treatments, might be more appropriate.

In terms of emotional impact, addressing the scar could potentially help alleviate the psychological distress associated with it. However, it's also important to consider the potential risks and outcomes of any procedure.

Could this old scar be removed with punch excision between philtrum? (Photos)

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