Nasal scar treatment- what should my next steps be? (Photos)

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Thank you for sharing your detailed history — it’s clear you’ve been very proactive and patient with your treatment journey, and that persistence is incredibly important when addressing complex scars, especially on delicate areas like the nose.

From what you’ve described, you’ve already undergone many of the most effective procedures available — CO₂ laser, RF microneedling, subcision, filler, and even fat grafting — and it’s understandable that you’re now looking for the final refinements, particularly for the residual depression and hypopigmentation.

At this stage, your focus should be on texture blending and color balance. CO₂ laser resurfacing can help smooth out the edges and even out the skin’s texture, especially when done carefully after fat or filler integration has stabilized. Using Bellafill to support the volume can also be a good option, as it offers longer-term collagen stimulation and may help maintain a smoother contour in the scarred area.

The hypopigmentation is indeed more challenging — but not impossible. Options like fractional laser treatments (using low-energy settings), microneedling with tranexamic acid or PRP, and targeted pigmentation treatments can help encourage repigmentation over time. Hydroquinone can help even tone if there’s darker pigmentation around the scar, but for lighter areas, topical treatments that stimulate melanocyte activity (like tacrolimus or certain laser-assisted pigment induction methods) might be more beneficial.

Your plan to consult a reputable plastic surgeon in St. Louis sounds excellent — ideally, you’ll want a specialist experienced in both scar revision and pigment restoration. With continued care and a conservative, step-by-step approach, you can expect meaningful improvement while preserving the natural shape and balance of your nose.

You’ve done a remarkable job advocating for your skin — now it’s about fine-tuning those final details.