Atrophic scar after revision rhinoplasty. What laser or scar treatments (CO2, fractional, etc.) would you recommend? (Photo)

Question

I underwent Revision Rhinoplasty over a year ago to correct asymmetry in my tip & address a small dorsal hump. Unfortunately, inadequate blood flow during the procedure resulted in an atrophic scar in my upper dorsal area. 4 months ago, my surgeon excised the scar & connected the tissue, improving it but leaving some atrophic scarring. Residual swelling also present. Certain angles are worse. Which laser or scar treatments would you now recommend? Fully ablative CO2? Fractional? Another?

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

Nelson Lee Novick, MD · Answer

An HD closeup of the scar would have been very helpful. From what can be seen, the scar appears quite superficial. If this is indeed so, then professionally performed manual Dermastamp microneedling (no need for the added expense and risks of RF microneedling) can work well for blending this area with the surrounding normal skin. Ablative C02, much like dermabrasion, is an aggressive procedure that engenders prolonged post-treatment downtime and involves the risks for scarring and dyspigmentation. The hard science to back the use of fraxel lasers, much like for so many of the other expensive, so-called energy-based gizmos out there simply lags woefully behind the heavy marketing hype and social media buzz. So a healthy dose of "buyer beware" is in order when being hawked any of these. You would be wise to consult a board certified cosmetic dermatologist scar specialist and best of luck.,

Atrophic scar after revision rhinoplasty. What laser or scar treatments (CO2, fractional, etc.) would you recommend? (Photo)

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Atrophic scar after revision rhinoplasty. What laser or scar treatments (CO2, fractional, etc.) would you recommend? (Photo)

Answers (2)

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Everything you need to know about Laser Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.