Scar on forehead from stitches 15 years ago. Best treatment? (photo)

Unfortunately, for scars over twelve weeks of age (i.e. "mature scars"), generally the greatest degree of improvement, even with proven treatments, such as subcision and professionally performed manual microneedling (no need for the added expense and risks of RF microneedling), is about a 60-80% overall improvement in appearance. From the photo provided, it is difficult to say whether the scar is indented. If so, then subcision can be used to elevate and smooth it. This can then be followed by microneedling for better blending the treated skin, in both color and texture, with the surrounding normal skinBe very cautious when evaluating all the expensive, "bells and whistles" fraxel lasers and RF devices out there, since the hard science to support their use lags woefully behind the heavy marketing hype and social media buzz to promote them. Scar revision surgery, especially in an area subject to a great deal of muscular dynamic and static movement, such as the forehead, runs the risk for subsequent stretch scar and stitch track formation. In fact, I have a patient who will be coming to me tomorrow who underwent forehead scar revision surgery and subsequently developed a surgical site infection and ultimately a worse scar that now needs to be treated. For optimal outcomes, most scars should be treated between the end of week four to the end of week twelve after their appearance. You would be wise to consult with an experienced, board certified cosmetic dermatologist acne scar treatment specialist. Hope this helps and best of luck.

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