Would subcision filler help minimize the appearance of a 20 year old scar on the nose? (photo)

I literally finished treating a patient with a similar issue between her eyebrows about one-half hour ago. I first performed a subcision to elevate and smooth the indented scar. This will be followed by Dermastamp microneedling (no need for the added expense and risks of RF microneedling) accompanied by the application of topical tyrosine and latanoprost to better blend any residual superficial surface textural and color irregularities with the surrounding normal skin. I have personally been performing subcisions since 1995 and microneedling for about twenty-four years with gratifying results. You would be wise to make sure that you are consulting an experienced, board certified cosmetic dermatologist and best of luck.

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

This response was dictated. I apologize in advance for any potential grammatical errors.
Treating acne, scar contour irregularities is inherently difficult, and there are many different approaches. People have suggested, tried and continue to recommend.
Unfortunately, none of them tend to do a really great job with consistent quality outcomes.
Before prescribing a surgical solution, we need to have a clear understanding of what the problem is.
is the problem a lack of volume? If so alone, should fix the problem.
Unfortunately, fillers, alone, or grafting fat typically does not improve the outcome. If anything can make the situation worse.
Deep, acne scars are generally a problem related to the style, nature of scar tissue, which Tethers the skin contour irregularity.
It’s a bit like tufted furniture.
Subs scission with volume restoration is generally as solid an approach.
Subs scission with volume restoration is generally as solid a approach.
The problem using fillers is that they will eventually dissolve in anytime you surgically release scar tissue. The body will respond by making more scar tissue.
Grafting that may seem like an optimal solution, but in order for grafted fat to remain viable, it Hass to be surrounded by sufficient host tissue, which makes grafting, small, precise areas, unpredictable.
The textbook answer for the treatment of Icepick acne scar is generally direct surgical excision with repair.
When done with great precision surgery on the nose, can heal with minimally visible scars.
Scars are often much less visible than contour irregularities.
People are often apprehensive of having a scar placed on their nose, but a well done surgical excision of the defect Usually gives a much better outcome if done correctly and if the contour problem is eliminated.
It may seem excessive, but when done correctly, it gives the best outcomes.
Before considering any surgical procedure, I suggest interviewing providers who have experience and asked them to show you before, and after pictures of other patients who’ve had the same procedure done, preferably showing long-term outcomes.
In regards to timing, I suggest you ask your rhinoplasty provider what their recommendation is.
Things should be pretty stable, three months after surgery, but there may be some persistent swelling and this could conceivably have some impact on the assessment of the acne scar.
Six months is a common time frame quoted before having secondary procedures in areas that were operated on previously.
I suggest you defer to the opinion of your providers.
Best,
Matt Hagstrom, MD