Which procedure would help minimize the appearance of indented scars that are becoming more noticeable with age? (photo)

Subcision, which I have been using since 1995 with gratifying results, is a relatively inexpensive technique that has a several decades' long history of safety and efficacy for elevating and smoothing all kinds of indented scars (from post-surgical, postinfectious, post-traumatic and acne) in all skin types. Although in may be used in conjunction with fillers, It does not require their use. You will probably be hawked this or that expensive fraxel laser or RF device. But, you would be well advised to exercise a healthy dose of buyer beware, since the hard science to support the use of these "bells and whistles" lags woefully behind the heavy marketing hype and social media buzz to promote them. Wishing the best of luck and the best for the holidays.

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

Acne scars are very difficult to improve. In my opinion a more aggressive approach is necessary to achieve improvement. I prefer CO2 or Erbium laser resurfacing.