How can I treat this depressed scar? (Photos)

Question

I underwent sessions of plasma, exosomes, and laser treatments, and used various creams; however, there has been absolutely no improvement. The affected area remains depressed below the level of the surrounding skin and is white in color. تم عمل جلسات بلازما واكسزوم وليزر وكريمات ومفيش تحسن خالص منخفضه عن الجلد واللون ابيض

Anna Chacon, MD, FAAD · Answer

Thank you for sharing your experience—and I can understand how frustrating it must feel to go through multiple treatments without seeing the improvement you were hoping for. What you’re describing—a depressed (atrophic), lighter-colored scar—can be one of the more challenging types to treat, but there are still effective options to consider.

Why This Type of Scar Is Stubborn

A scar like yours typically has two key features:

Volume loss (depression): The skin sits lower because of lost collagen or underlying support
Loss of pigment (hypopigmentation): The white color means melanocytes (pigment cells) are reduced in that area

Many treatments like PRP, exosomes, and general lasers focus on stimulating the skin—but if the structure underneath hasn’t been adequately restored, the improvement can be limited.

What Can Help Improve It

1. Subcision (Very Important for Depressed Scars)
This is often one of the most effective treatments for a scar that sits below the skin. A small instrument is used to gently release the fibrous bands pulling the scar downward.

Helps “lift” the scar closer to the surface
Often combined with other treatments for better results

2. Filler for Structural Support
After releasing the scar, placing a small amount of filler underneath can:

Restore lost volume
Prevent the scar from reattaching downward
Improve the contour more immediately

3. Targeted Microneedling or RF Microneedling
These can help rebuild collagen over time, especially when used after subcision, not as a standalone treatment.

4. Treatment for the White Color (Hypopigmentation)
This part is more difficult, but options include:

Excimer laser or targeted light therapy to stimulate pigment
Micropigmentation (medical tattooing) in select cases
Sometimes, pigment improves slightly once the skin structure is corrected
Why Previous Treatments May Not Have Worked
They likely did not address the tethering beneath the scar
Collagen stimulation alone is often not enough for deeper depressions
Hypopigmentation does not always respond to standard resurfacing
A Realistic Expectation

While complete “erasure” of the scar may not be possible, meaningful improvement in both depth and visibility is very achievable with the right combination approach—especially starting with structural correction like subcision.

A Reassuring Perspective

You’ve already tried many of the common first-line treatments, which tells me you’ve been very proactive. The next step isn’t to keep repeating what hasn’t worked—it’s to shift strategy toward mechanically lifting and rebuilding the area.

Even scars that seem resistant can improve when approached from the right angle, and your situation still has options worth exploring.

Salar Hazany MD, FACMS · Answer

This type of scarring can be particularly resistant if the core issue&mdash;loss of underlying support&mdash;hasn’t been addressed. In cases like yours, treatments such as PRP, exosomes, topical creams, and even some lasers often don’t make a meaningful difference because they don’t adequately lift the scar back to the level of the surrounding skin, so the most effective approach is usually structural correction, specifically subcision (which releases the fibrous bands pulling the scar downward) often combined with a collagen-stimulating filler like Sculptra to gradually rebuild volume and improve contour over time, and while more aggressive lasers can sometimes help as an adjunct, they typically aren’t sufficient on their own for a true depressed scar.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis. We see atrophic and hypertrophic scars, as well as scars that have hypo and hyperpigmentation. 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 discuss the best treatment options for your type of skin. .

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Laser Skin Solutions - Portland · Answer

Uncovering why a depressed, atrophic white scar has resisted multiple sessions of plasma therapy, exosomes, topical creams, and lasers involves analyzing how damaged dermal architecture reacts to sustained trauma. While superficial resurfacing modalities and regenerative topicals like exosomes are excellent for stimulating epidermal turnover and mild collagen remodeling, a deep, tethered atrophic scar often involves sub-dermal fibrosis or structural adhesions that anchor the skin downward.As an advanced licensed esthetician in Portland, I frequently consult with individuals seeking solutions for stubborn scars that have plateaued with surface-level treatments. To determine the most effective next steps, several clinical factors should be considered:Addressing Subsurface Tethering: If the depression is caused by fibrous bands pulling the skin downward from beneath, surface lasers and topicals cannot release that mechanical tension. In such cases, treatments like targeted subcision are typically required to physically break the tethering adhesions and allow the base of the scar to lift.Restoring Volume and Dermal Support: Once any underlying restriction is released, introducing structural support through modalities such as precision dermal fillers, autologous platelet-rich fibrin (PRF), or fat grafting can help fill the void and restore a smoother, more even contour with the surrounding skin.Because every scar architecture and tissue response is unique, an in-person clinical assessment with a board-certified dermatologist, plastic surgeon, or qualified specialist is essential to evaluate the depth of the depression and determine the safest, most effective revision plan.

How can I treat this depressed scar? (Photos)

Answers (4)

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