8 years post-op punch incision - How can I fix this indented scar on my cheek? (photos)

Question

I posted in 2014 on here because my scar was not looking good three weeks after the procedure. Eight years later now, I have a very deep indentation scar on my cheek from punch excision of cyst, pls see photo. What is my best course of action to make this not look so indented? Will microneedling help? I am hesitant with lasers because of horror stories. Thank you.

Dallas Buchanan, MD · Answer

Thank you for your questions and picture. I think that there are options for you out there. I would start with microneedling and maybe consider RF microneedling (Morpheus8) to smooth the skin and work on the texture. If there is still a depth defect there, then I would consider subcision and possibly HA filler or Renuva to correct the indent.

Hope this helps!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Hope this helps!

Dallas Buchanan, MD
VIVIFY plastic surgery
Tampa, FL

Raffy Karamanoukian, MD, FACS · Answer

The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

Depressed scars can be improved with vascular lasers like Yellow laser, BBL, or Excel V when they are red --- and with CO2 spot treatments, fillers, microneedling with PRP, and subcision to help with texture and blending. I recommend getting a formal evaluation with a scarring expert. Best, Dr. Emer​

Nelson Lee Novick, MD · Answer

So sorry that you have been suffering this long. I stopped performing punch excisions, particularly in areas, such as the cheeks, that are subject to much movement and/or static muscular tension, since they often give subsequent rise to indented stretch scars and often even to tram track stitch scars. I also appreciate your concern regarding the use of lasers, especially since the hard science to support their use continues to lag well behind the device manufacturer backed marketing hype to capitalize on their supposedly being the "next big thing." Subcision is a simple, relatively inexpensive and time-tested technique for elevating and smoothing all kinds of indented scars, including those following surgery. I have personally been performing it regularly for this purpose since 1994. You would be wise to consult with a board certified cosmetic dermatologist with extensive scar treatment experience. Best of luck.

Derakhsh Fozouni, MD · Answer

Hello there!
Lasers can be a great option for some people but, they do require downtime and some risks. If you are not willing to go that route, no problem. Luckily there are several options for you :)
Microneedling with PRP or PRF will help you with that scar tremendously. You usually require several treatments for optimal results. You can also get a dermal filler injected by an experienced injector.
Depending on your budget and what suits you best you could combine both treatments (microneedling and filler) or stick to only one and wait. 
Hope this helps!

8 years post-op punch incision - How can I fix this indented scar on my cheek? (photos)

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