Removal of an Old Deep Facial Scar (photo)

I am currently 21 years old. When I was 14, I had a mole on my cheek that kept growing and it had to be removed. I was left with a scar. Not only is it slightly depressed, but it also seemed to have bunched up at either end, resulting in raised skin. What should my next steps be? I live in NYC. Do I search for a dermatologist or for a plastic surgeon? Is there a chance of correcting the scar/making it less visible, or is it not worth trying to remove?

Doctor Answers 3

Removal of an Old Deep Facial Scar

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The photos help thanks, Reading the previous experts in detailed operative plan is one alternative. From my perspective I would offer an excision of the depressed/total scar than layered closure and laser sanding. But you would be best to seek in person opinions. Regards 

Depressed Scars Respond Well to A Combination of Subcision and Medical Microneedling

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Depressed scars, regardless of the prior cause (surgical, traumatic, acne, infectious) generally have two main aspects that must be addressed by treatment in order to achieve a gratifying aesthetic result.

The first goal is to lift the depression itself as much as possible to achieve smoother skin. The appearance of any depressed area of skin (whether due to a scar, wrinkle or fold) is accentuated by what is known as the "craters on the moon" effect. The shadows cast from side lighting darken the base of the scar, and, it's a rule that makeup experts know well and put to good use that anything that lightens an area increases the illusion of being outwardly projecting. A white makeup pencil can lighten the base of a scar and make it seem less depressed. But, this is of course temporary.

Subcision, however, can be used if we are looking for a more permanent solution. Subcision is a process whereby a small cutting needle is inserted directly under the scar  (following the administration of local anesthetic) in order to break up the thick fibrous scar bands that  pull the surface downward. At the same time, we create a space for new, healthier collagen to be laid down to fill, bolster, and elevate the base of the scar and smooth it with the surrounding normal skin.

Scar tissue typically possesses and an abnormal ivory-like color and abnormal surface texture. Medical microneedling can be used to address these issues, if desired, This treatment involves the use of an array of sterile needles that are rolled over the scar (following local or topical anesthetic application). On a microscopic level, and in a fractionnated pattern, the needles  break up the abnormal surface characteristics and coloration and permit the development of a more even coloration and texture following healing. To hasten the process, not uncommonly, subcision is combined with medical microneedling at the same treatment session.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Steps to improve a scar on the nasolabial folds of the face

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The goal of the scar revision would be to hide the scar as much as possible.  I would recommend the following:

  1. Scar excision
  2. Z plasty to realign the incision
  3. Fractional CO2 laser skin resurfacing

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 95 reviews

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