Atrophic scar that has lost volume and is now shiny and hyper-pigmented - how can I fix this? (Photos)

Question

Hello! I need help on how to get rid of this very old scar on the bridge of my nose. I got it 8 or so years ago after crashing on my bike and hitting the pavement. I would be thrilled to have improvement in both volume and the lightening of pigment, the hyperpigmentation is my least favorite aspect of it. The scar: In certain angles, you can see where it's flat from volume loss, and that part of the skin has a shine to it from newly rebuilt fibers. The discoloration has lightened up over the years, and goes back to darkening with the sunlight (I do wear SPF). I NEED HELP! It's in the center of my face and I am so uncomfortable living with it:(

Anna Chacon, MD, FAAD · Answer

I completely understand how something like this—especially right in the center of the face—can feel very distressing. What you’re describing is actually a combination of texture change (atrophic scarring with volume loss) and post-inflammatory hyperpigmentation, and both are very treatable, just in different ways.

The “shiny” appearance you’re noticing is very typical of older atrophic scars. It usually happens because the skin in that area has thinner dermis and altered collagen structure, so it reflects light differently than the surrounding skin. Even though it has healed, it hasn’t fully rebuilt normal support underneath.

For the volume loss, I typically think in terms of structural correction first. In some cases, a small amount of carefully placed hyaluronic acid filler can help lift that depressed area and immediately soften the contrast. If the scar is more tethered or fibrotic, subcision followed by filler can give a more natural and longer-lasting improvement because it releases the underlying scar tissue first before restoring volume.

For the texture and collagen remodeling, procedures like fractional laser resurfacing or RF microneedling can gradually improve that shiny, thinned appearance. These treatments help stimulate new collagen formation over time, which is really what you need to rebuild healthier skin quality in that area.

For the hyperpigmentation, this part often takes consistency and time. Even if you’re using SPF (which is great and absolutely necessary), scars like this can still darken with sun exposure. I usually recommend:

Daily broad-spectrum SPF 50+, preferably tinted
Topicals such as azelaic acid, retinoids, or short cycles of hydroquinone when appropriate
In select cases, light chemical peels or pigment-targeting laser treatments

The most important thing to know is that this type of scar almost always improves with a combination approach, not a single treatment. We’re not trying to erase it completely, but to soften the edges, restore subtle volume, and bring the pigment closer to your natural skin tone so it blends much better.

With the right stepwise treatment plan, I do find that patients see meaningful improvement in both texture and discoloration over time.

Nelson Lee Novick, MD · Answer

So sorry that this happened to you. 
At least from your description and photo, it would appear that you could profit from simple Subcision in order to elevate and smooth the scar followed by manual Dermastamp micronedling (no need for the added expense or risks of RF microneedling) accompanied by the application of topical Rx skin lightening agents to improve and better blend both the color and texture of the area with the surrounding normal skin. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck.

Atrophic scar that has lost volume and is now shiny and hyper-pigmented - how can I fix this? (Photos)

Answers (2)

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