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

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

Thank you for your thoughtful question.
You’re certainly not alone in your experience—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—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—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—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—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—especially around the nose bridge and under-eye—where its effects can be too aggressive.