What's the best treatment for papular/hypertrophic acne scar on nose? (Photo)

I have been treating papular acne scars for many years with gratifying results--long before it even got its relatively recent appellation.
Papular acne scar bumps most typically appear on the chin and/or nose. Since they are essentially small hypertrophic scars, I usually suggest three test areas to assess the approach for any particular patient. These include the use of anti-inflammatory intralesional injections; Scalpel Sculpting; and light electrocautery. In most cases, the latter is turns out to be the most common path taken. One or more treatment sessions are typically required to achieve the desired improvement.
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck.

Treating papular or hypertrophic acne scars, especially on the nose, can be challenging, particularly if previous CO2 laser treatments have not been effective. Here are some alternative treatment options to consider:

Steroid Injections: Intralesional corticosteroid injections can help flatten hypertrophic scars by reducing inflammation and scar tissue formation.

Silicone Gel or Sheets: Regular application of silicone gel or sheets can help in softening and flattening raised scars over time.

Microneedling: This procedure can improve the texture of the skin by stimulating collagen production, which may help in reducing the appearance of raised scars.

Pulsed Dye Laser (PDL) or Intense Pulsed Light (IPL): These treatments can reduce redness and may help in flattening hypertrophic scars by targeting the blood vessels within the scar tissue.

Cryotherapy: This involves freezing the scar tissue, which can help reduce its size. It is often used in combination with other treatments such as steroid injections.

Surgical Excision: In some cases, surgical removal of the scar tissue followed by meticulous wound care can result in a flatter, less noticeable scar.

Fractional Laser Therapy: Consider trying a different type of fractional laser that might be more effective for your specific scar type and skin.

Consult with a board-certified dermatologist or plastic surgeon who has experience in treating hypertrophic scars. They can evaluate your specific condition and recommend the most appropriate treatment plan tailored to your needs.

Thank you for your inquiry! Lasers such as Microneedling can be performed to minimize appearance of scars. We would love to see you in person or virtually to discuss treatment options or schedule a consult with a licensed aesthetician to make a plan for you!

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Bleomycin, a chemotherapeutic agent, has been effectively used off-label in dermatology for treating various skin lesions, including papular scars on the nose. The advantages of using bleomycin for such scars include:
Effectiveness in Scar Reduction:
Bleomycin works by inducing apoptosis (cell death) and fibrosis modulation, which can help flatten and smoothen raised papular scars.
Non-Invasive Administration:
Bleomycin can be delivered via techniques like intralesional injection or microneedling, which are less invasive compared to surgical methods.
Minimal Systemic Side Effects:
When used in localized low doses, bleomycin carries a low risk of systemic side effects, making it relatively safe for small, targeted areas like the nose.
Targeted Action:
The medication is highly effective in targeting abnormal fibroblast activity in scar tissue, thereby improving the texture and appearance of the skin.
Alternative for Resistant Scars:
Bleomycin is often effective for scars that do not respond well to other treatments such as corticosteroids or laser therapy.
Cost-Effective:
Compared to some laser treatments or surgery, bleomycin is a more affordable option for managing papular scars.
No Downtime:
The procedures associated with bleomycin typically have minimal recovery time, allowing patients to resume daily activities quickly..
Find a scar expert.
Jeff Rapaport MD FAAD
Realself Hall of Fame
Castle Connolly Top Doctor