What can be done to address 2 year old white and textured commissuroplasty scars? (photos)

Question

I have a long white, textured scar along the vermilion border of my lip on one side from a previous commissuroplasty; it's not very raised but the texture and color bothers me as it is quite obvious and can't be disguised with makeup. I'm wondering what I can do to reduce this scar—would laser treatments or biocorneum/scar gels work for a scar almost 2 years old? What are my options? Does microneedling do anything for this type of scar?

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your concerns and the detailed photos, they’re very helpful.

Scars from commissuroplasty, especially ones that are two years old, can be persistent but are often still treatable with the right combination of approaches. Based on the white coloration and textural difference you described, here are some options to consider:

Fractional Laser Resurfacing (e.g., CO2 or Er:YAG):
This is one of the most effective treatments for older, textured scars. It can help smooth the scar and reduce pigmentation differences by stimulating new collagen production and resurfacing the skin.

Microneedling with PRP (Platelet-Rich Plasma):
While microneedling alone may offer mild improvement, combining it with PRP can enhance collagen remodeling, helping improve both texture and appearance over time.

Silicone-Based Scar Gels (e.g., Biocorneum):
These are best for newer scars, but you may still see some benefit in terms of softening and slightly fading the scar. However, at this stage, they are unlikely to make a dramatic difference on their own.

Steroid or 5-FU Injections:
If any part of the scar becomes raised or firm, injections can help flatten and soften the area.

Vascular Laser (e.g., pulsed dye laser):
If there’s any residual redness or vascular component, this can help reduce color mismatch between your natural lip and the scar.

Camouflage Techniques:
Medical-grade pigmentation camouflage or tattooing is an option if laser or microneedling results are limited, especially for color blending.

Next Steps:
A combination approach is often most effective. I’d recommend starting with a fractional laser consultation to assess depth and density of the scar. Depending on how your skin responds, microneedling or additional laser sessions may follow.

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

Jeffrey H. Spiegel, MD · Answer

Your best move is to come in, and have us rework that scar. It should be readily improved to a good degree.

Nelson Lee Novick, MD · Answer

The short answer to your question is yes. Professionally performed manual microneedling (no need for the added expense and risks of RF microneedling) accompanied by the application of Rx topical pigment enhancers can address the hypopigmentation and superficial textural irregularities of the scar in order to better blend the scar with surrounding normal tissue. Hope this helps and best of luck.

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