Atrophic scar after mole removal? (Photo)

Question

Around 4 months ago I had a mole removed surgically. The outcome was not as expected as I am left with a visible scar. I know that it's still early to get it treated but I would like to know if there are any treatments that I can get when it's fully healed. Would subcision and microneedling work even if is located on the lip board? Or the best way is to have it surgically removed again and hope for the best? Thanks in advance.

Nelson Lee Novick, MD · Answer

It is absolutely not too early to have the scar treated. In fact, the ideal time frame for having treating imminent scars in order to optimize the outcome is between week four and week twelve following the initial cause, which can be acne, infection, trauma, or, as in this case, surgery. The old advice for  waiting a full year for a scar to fully mature went the way of the dodo in the late 1980s, when it was found that early dermabrasion, no later than week twelve offered the best chance for possibly even "erasing" a potential scar, after which only improvement was possible. From the photo, subcision, to elevate and smooth the scar, followed by manual Dermastamp microneedling (no need for the added expense and risks of RF microneedling) for blending the surface of the scar better in both color and texture with the surrounding normal skin, would be very reasonable treatment approaches. Both techniques have an excellent, several decades" long track record for both safety and efficacy. You would be wise to make sure to consult a board certified cosmetic dermatologist scar specialist. And, finally, for going forward, you would also be wise to consider Scalpel Sculpting, a mole removal method that requires no deep cutting and no stitches, which translates into no potential for post-surgical stretch marks or stitch tracks. Hope this helps and best of luck.

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

Mats Hagstrom, MD (license on probation) · Answer

Sometimes surgeons attempts at keeping things minimal leads to undesirable outcomes.
To realistically create a better contour, you probably will need a lip, wedge excision.
Whether that is desirable or appropriate is something you probably need to think about.
What kind of doctor did the mole removal? 
Consider having a few in person, consultations with senior board-certified, plastic surgeons or facial plastic surgeons, who seem to be highly meticulous. Ideally providers would have before, and after pictures of previous patients who had lip lesions in the past.
It may seem drastic to take a whole wedge out of the lip, but in the end it tends to heal better.
I don’t think simplistic treatment options are going to give you satisfactory outcomes.
Best,
Mats Hagstrom, MD

Atrophic scar after mole removal? (Photo)

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