Treatment options for an ugly knee scar? (Photos)

Question

I have a pretty nasty scar from a fall it's almost two years old. it's a wrinkly patch with indented hair follicles and one slighty more raised line from a deeper cut. ive got one steroid shot which cause the surrounding skin to indent for a while and left a hole where it was injected however made little to no difference on the actual scar. ive been using silicon gel as well as Gell sheets but the scar still looks pretty bad and noticeable. I want to know the treatment options as well as how much improvement could I potentially see.

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

It would be wise to first flatten the linear, elevated, hypertrophic portion of the scar via the use of intralesional injections of anti-inflammatory agents, such as triamcinolone acetonide. 
Once a uniformly flat surface is achieved in this fashion, then professionally performed, manual Dermarolling Microneedling (no need for the added expense and risks of RF microneedling) can be performed on the overall scar, accompanied by the topical application or the intradermal injection of HA skin Boosters,  in order to improve the overall skin texture of the scar and blend it better with the surrounding normal skin.
Please note, the hard science to back up the use of many of the expensive, so-called "next big thing" fraxel lasers and other gizmos being offered out there lags well behind the heavy marketing hype and social media buzz to promote them. So, exercise a healthy dose of "buyer beware" when being offered these approaches. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

Possible treatments for your knee scar include:

Laser Therapy – Fractional laser or CO2 laser can help smooth out the texture and improve pigmentation.
Microneedling with PRP – Can stimulate collagen production and help with indentations.
Steroid Injections – Though one caused indentation, a tailored approach may help if the raised portion is still prominent.
Filler Injections – Temporary dermal fillers can help even out indented areas.
Surgical Revision – Excision and re-closure can improve the scar’s appearance, especially if it is wide or irregular.
Chemical Peels – Light to medium-depth peels can improve texture over time.
Silicone Therapy – Continue with silicone sheets/gels, as they work gradually.
Topical Treatments – Retinoids or prescription creams may aid in scar remodeling.
Improvement depends on the treatment, but many patients see 30-70% enhancement. Consulting a dermatologist will help determine the best approach for your specific scar.

C. William Hanke, MD · Answer

The knee is a difficult area for healing due to constant movement. Unsightly scars are common. I would suggest trying fractionated CO2 laser for possible improvement.

Treatment options for an ugly knee scar? (Photos)

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Treatment options for an ugly knee scar? (Photos)

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