What can I do to flatten this eight year old scar from mole removal? (Photos)

Question

About eight years ago, I had this mole underneath my nose treated several times with cryotherapy, and eventually my GP treated it with cauterization. This was done purely for cosmetic reasons. What remains is a colorless scar that is still slightly raised. It’s the texture that still bothers me. In lighting like this it’s very obvious to me. I’m wondering whether it would be wise to have anything else done to it, like scar removal or treatment. I want the color to remain the same, because it’s the same color as my skin right now. I just want to flatten it so it’s less noticeable. I would really appreciate your honest opinion about whether i should treat this scar and if yes how?

Anna Chacon, MD, FAAD · Answer

I can understand why the texture bothers you, especially when the lighting makes the raised area more noticeable. The fact that the scar is already skin-colored and has remained relatively stable for eight years is reassuring from a cosmetic standpoint. What you're describing sounds more like a mature, localized raised scar than an active inflammatory scar, although the exact diagnosis can't be made from photographs alone.

Because it is eight years old, I would not expect creams or silicone products to dramatically flatten it at this point. Silicone is most useful for raised scars during the healing and maturation process.

What could actually improve the texture?

If the main problem is that the scar sits slightly above the surrounding skin, there are several possibilities:

Fractional laser resurfacing: This can remodel the collagen within a mature scar and make its surface smoother and less noticeable. Multiple treatments may be necessary, and the response depends on the depth and type of scar.
Very conservative scar revision: If the scar is small and distinctly raised, surgical excision followed by meticulous closure can sometimes produce a flatter, less noticeable scar. The important thing to understand is that this replaces the existing scar with a new surgical scar rather than eliminating scarring altogether.
Steroid injection: Kenalog or another corticosteroid can flatten hypertrophic scars, but I would be cautious with this in your situation. If the elevation is minimal, steroid can potentially cause an indentation or thinning of the surrounding skin. Corticosteroid injections are primarily used for genuinely raised/hypertrophic scars and keloids.

Since your priority is keeping the color exactly as it is while improving the elevation, I would be particularly conservative with treatments that can alter pigmentation. Lasers can sometimes cause temporary or permanent pigment changes, especially in people with more pigment-prone skin.

I also wouldn't rush to have the scar surgically removed simply because it is visible in certain lighting. If the bump is very small, a conservative resurfacing approach may be preferable to creating another incision directly under the nose. On the other hand, if it is a discrete, firm mound of scar tissue, surgical revision may give a more predictable flattening than resurfacing alone.

One other point: because the original lesion was a mole that was treated several times with cryotherapy and then cauterized, I would want to be certain that the area truly represents scar tissue before treating it cosmetically. A dermatologist should examine any persistent lesion before laser treatment or revision, particularly if it has changed in color, size, shape, or symptoms.

My honest opinion: if the only issue is a small, stable, skin-colored elevation and you otherwise like the appearance, I would favor the least aggressive option that can improve the texture, rather than immediately excising it. A mature scar can be made less noticeable, but there is no procedure that guarantees a completely scar-free result.

Nelson Lee Novick, MD · Answer

At least from the photo provided, it would appear that simply Scalpel Sculpting off of the elevated portions of the scar so that it becomes flush with the surrounding normal skin would be a simple approach to achieving what you want. In the hands of an experienced, board certified cosmetic dermatologist scar treatment specialist, the entire procedure, following the administration of a small amount of local anesthesia, should literally not take more than a minute to perform, following which there would be a short healing period of about ten days during which you would be applying plain Vaeline twice daily. A Field Subcision, unlike the use of an intralesional injection of triamcinolone (another potential approach to flattening a scar), would not run the risk of atrophy (sinking in) of the area. Hope this helps and best of luck.

What can I do to flatten this eight year old scar from mole removal? (Photos)

Answers (2)

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