Indentation on face (chicken pox scar)? (Photo)

Question

Dear doctor, Have a small indentation (about 5mm in diameter) post chicken pox scar on my cheek. May I know what is the best method to remove it permanently and its cost? Appreciate your help!

Nelson Lee Novick, MD · Answer

Unfortunately, at present, there is no procedure or even set up techniques that can completely eliminate any kind of scar, including those resulting from chicken pox. That having been said, there are a number of procedures that can improve and in many cases improve considerably the appearance of these scars. These techniques include subcision to free up and elevate the bound down base of each pox scar--performed either alone or in tandem with the injection of a biostimulatory filler to further elevate the scar base and to promote new, native collagen synthesis. In my Upper East Side Manhattan office, I typically choose the filler, Restylane Lyft, and in my Israel satellite facility, where a far greater number of regulatory agency approved fillers are available, Hyaluronica 2. Since the borders of the scar are quite steep, you might also benefit from light electrodessication or manual dermasanding of the rims of the scar to diminish its "craters of the moon" effect and make the scar more "rolling.'  And, finally, medical microneedling of the scar surface may also be needed in order to improve any residual tonal and textural irregularities and to permit better blending with the surrounding normal skin. Fees may range from 250-475, depending upon which of the above are actually needed in this particular case. It is important to bear in mind that typically a series of subcision and microneedling treatments is often required in order to achieve optimal results, with a minimum of a six week interval between treatments. Make sure that you seek consultation and treatment by a board certified aesthetic physician with experience and expertise with all forms of scar treatments. Best of luck to you.

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 been 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 laser 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

Robert M. Tornambe, MD · Answer

I appreciate your concern, and while physical exam would be beneficial, it appears that scar revision is your best option for complete removal. It can be done in the office, under local anesthesia, but does mean that you will be trading this very apparent and noticeable scar for hopefully a much less obvious, thin scar that is easier to cover with makeup or blend in with your face. Cost should rune approximately $700-$1500 in NYC by a board certified plastic surgeon. Laser resurfacing may also be an option, but I do not think that it would completely remove it. Be sure to consult with a board certified plastic surgeon. Good luck!

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