Is Punch Excision the best solution for boxcar scar on forehead? (photos)

Question

I have (among other scars) a large circular boxcar scar featured prominently in the center of my forehead. Wondering if punch excision would be the best way to address this scar. I'm also considering CO2 and RF (ematrix), but I'm concerned that the marginal improvement with those devices will be inferior to simply cutting out the scar completely. On a side note, I also happen to have impressively large pores, so any tips there would be appreciated too. Thanks in advance.

Raffy Karamanoukian, MD, FACS · Answer

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

Nelson Lee Novick, MD · Answer

In areas, such as the forehead, subject to static tension and/or movement, the risk of stretch scar development and tram track formation (from the stitches)--which can be more cosmetically troubling than the original scar-- is a real concern. At least from the photo provided, the center scar does not appear particularly deep. If so, then professionally performed microneedling (no need for the more expensive "bells and whistles" RF variety) can help not only to improve the scar, but to improve the surrounding enlarged pores. If the central scar is actually deeper than it appears, then subcision can help to elevate and smooth the scar, which can then be followed by the microneedling. Alternatively, TCA CROSS can be used for the central scar, which again can be followed by the microneedling. In the 28 years I have been routinely performing subcisions,; and the over two decades I have been performing TCA CROSS and professional microneedling, they all have proven to be safe and effective in all skin types. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Hope this helps and best of luck.

Is Punch Excision the best solution for boxcar scar on forehead? (photos)

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Is Punch Excision the best solution for boxcar scar on forehead? (photos)

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Everything you need to know about Punch Excision

Our mission is to create a world where every investment in modern beauty is Worth It.