Options for permanent removal of sunken scar on nose? (Photos)

Question

I would like to hear about any options to get rid of this sunken scar that I have had for over 20 years. The scar resulted from getting struck in the nose by a heavy object. I am looking for possible permanent treatment and not just fillers. Is there any procedures, surgical or not, that would help here?

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Consider simple subcision for elevating and smoothing sunken scars from all causes, including prior trauma, as in this case. Since the procedure depends upon the person producing his/her own collagen and elastic fibers in response to the treatment (rather than simply plumped up temporarily by a filler), the results of subcisions are typically permanent.  Scar revision surgery, especially in areas subject to a great deal of static muscular tension or dynamic muscular movement, such as the nasal bridge/glabella region, carries a significant risk for the subsequent development of stretch scars and even tram track stitch marks. And expensive fraxel lasers and RF gizmo treatments, which will no doubt be hawked to you along the way, are backed far more by marketing and social media hype than hard science. So, buyer beware when it comes to considering these approaches. Make sure to consult a board certified cosmetic dermatologist, and best of luck.

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