What kind of laser is best for a raised dog bite scar on the lips? (Photos)

Question

I have a scar on my lip from a dog bite that happened 6 months ago. It was sutured in the ER and did not go past the vermilion border of my lips, but a chuck (about 1/4 inch) was detached and sewn back on by a plastic surgeon. Since the bite I have had 2 Kenalog shots in my lip, but I am still left with a red, vascular bump on my lip that people are saying looks like a cold sore. After having an ultrasound done on the scar, he doctor told me this scar had minimal actual scar tissue but was inflamed. He said this may eventually lay flat but if it stays chronically inflamed it may not. My question is, what kinds of lasers would be best for a scar like this? I have heard V beam or other pulsed lasers are good for reducing the redness, but will it be deep enough to take down the inflammation? The doctor recommended Ng:yag, but I’ve heard that CO2 lasers would be a better option. Any help is appreciated, this is overwhelming.

Anna Chacon, MD, FAAD · Answer

From what you’re describing—and especially with the ultrasound showing minimal true scar tissue and more inflammation/vascularity—this is actually an important distinction.

In cases like yours, the goal is not to “resurface aggressively,” but to calm down vascular activity first.

Here’s how I would typically approach it:

Pulsed dye laser (VBeam)
This is usually my first-line option for red, vascular, inflamed scars.
It targets the redness and blood vessels driving the inflammation.
→ This is very likely what you actually need at this stage.
Nd:YAG laser
Can sometimes help with deeper vascular components, but I don’t usually start here for a lip lesion like this unless there’s a specific reason.
CO2 laser
I would not start with CO2 in your case.
CO2 is for texture and scar remodeling, not active inflammation. If used too early, it can sometimes worsen irritation.

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

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

What kind of laser is best for a raised dog bite scar on the lips? (Photos)

Answers (2)

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