Nose scar treatment - any advice where to start? (Photo)

Question

I had an unfortunate skin reaction to Roaccutane several years ago, forming a blister, and now heavily indented scar on the bridge of my nose. It's not like any other scar I've seen online, so I'm not sure what kind of derm or surgeon to go to. It's quite deep, an unusual shape, and white. Any advice where to start?

Nelson Lee Novick, MD · Answer

Revision surgery, particularly in areas that are subject to dynamic or static muscular tension, runs the risk for the subsequent development of stretch scars and even tram track-like stitch marks.
Instead, consider the use of simple subcision, which can be used to elevate and smooth all kinds of indented scars from all causes, and which I have personally been performing for the past thirty years with gratifying results. 
For repigmenting the hypopigmentation, consider the use of manually performed Dermastamp microneedling (no need for the added expense or added risks of RF microneedling) accompanied by the application of Rx pigment promoting agents, such as latanoprost. that I have been employing for the past twenty-five years with gratifying results. 
No doubt in your research you will encounter suggestions for the use of this or that latest and expensive, supposedly "next big thng" fraxel lasers or other energybased gizmos for your problem. I caution you to exercise a great of "buyer beware? when considering these, since the hard science to back up their use lags well behind the heavy duty marketing and social media buzz to promote them.
You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist and best of luck.
.

Anna Chacon, MD, FAAD · Answer

Addressing a deep, indented scar on the nose can be challenging, but there are several options and steps you can take to improve its appearance. Here’s a guide to help you get started:

1. Consultation with a Specialist:

Dermatologist: Start by consulting with a board-certified dermatologist who specializes in scar treatment. They can provide a thorough evaluation and recommend appropriate treatments based on the scar's characteristics.
Plastic Surgeon: If surgical intervention is considered, a plastic surgeon with experience in facial reconstruction might be consulted to assess options for scar revision.
2. Treatment Options:

Laser Therapy: Fractional lasers, such as CO2 or Erbium, can help resurface the skin and reduce the depth of the scar.
Microneedling: This procedure can stimulate collagen production and improve the texture and appearance of indented scars.
Dermal Fillers: Temporary fillers can be used to elevate the scar to the level of the surrounding skin, though this may require maintenance treatments.
Chemical Peels: Superficial peels can help improve skin texture and pigmentation, but deeper peels might be necessary for significant improvement.
Surgical Options: For very deep or complex scars, surgical scar revision might be an option to alter the scar’s appearance.
3. Additional Considerations:

Scar Creams and Silicone Gel: Over-the-counter treatments and silicone gel sheets can be used to soften and flatten scars, though they may have limited efficacy on deep scars.
Skin Camouflage: Professional makeup techniques can help conceal the scar for cosmetic purposes while pursuing other treatments.
4. Emotional and Psychological Support:

Consider seeking support or counseling if the scar significantly impacts your self-esteem or quality of life.
5. Ongoing Care:

It’s essential to protect the scar from sun exposure, as UV rays can worsen its appearance. Use a broad-spectrum sunscreen daily.
Starting with a consultation will help you determine the best treatment path tailored to your specific needs and skin type. Each scar is unique, and a personalized approach is essential for optimal results.

Chet Mays, MD · Answer

Thank you for your inquiry! Scar creams can be used on scars to minimize appearance as well as silicone scar sheets. Lasers such as Microneedling can also be performed to minimize appearance as well. We would love to see you in person or virtually to discuss treatment options or schedule a consult with a licensed aesthetician.

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

Selcuk Yazan, MD · Answer

Thank you for your thoughtful question. 
You’re certainly not alone in your experience&mdash;Roaccutane (also known as isotretinoin) is a powerful treatment, but it must be used with precision and understanding, especially when it comes to facial anatomy.
Roaccutane works by suppressing the sebaceous (oil) glands, reducing oil production, and minimizing the size of pores. However, in doing so, it can also significantly strip moisture and compromise the skin’s ability to maintain support&mdash;especially in areas where there is little to no underlying fat, like the upper nasal bridge or the orbital (under-eye) area. When used over these delicate zones, Roaccutane can contribute to skin thinning or even localized atrophy, as the skin there has no cushion of fat or glandular support&mdash;just bone and dermis.
This may be what led to the development of a pale or depressed scar. The skin in that region may have lost its deeper support system, making it harder for the dermis to regenerate normally.
For treatment, the most effective approach is often not about filling, but rather rebuilding the foundation. It might be worth looking into:
PRP (Platelet-Rich Plasma) treatments in a series of sessions to encourage collagen production and enhance skin quality.
In some cases, microfat grafting&mdash;not to volumize, but to deliver a microscopic amount of fat to support the skin and stimulate healing. It’s essential that this fat is placed with care, purely to nourish the area&mdash;not to add bulk.
If your basal membrane is still viable, there is every reason to be hopeful that improvement can be achieved with the right care. 
And if you’re someone considering Roaccutane in the future, it’s important to avoid applying it over areas of thin skin&mdash;especially around the nose bridge and under-eye&mdash;where its effects can be too aggressive.

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