Any options for improving my scar? (Photo)

Question

Do I have any options improving my old surgery scar? If a surgery would be the best for me, would the new scar be longer than original? I got 3 sessions rf microneedling last fall, but no help. Please, need advice!

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. 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 decide whether early subcision should be started.

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nadir Qazi, DO · Answer

Thank you for your question regarding improving an old surgery scar. There are several options available for improving the appearance of scars, and the best option for you will depend on the type and severity of the scar. It's difficult to say based on the photo provided but if non-surgical treatments like RF microneedling have not provided the desired results, surgical scar revision may be an option. Scar revision surgery involves removing the old scar and creating a new incision that is designed to heal more smoothly and blend in with the surrounding skin. Depending on the size and location of the old scar, the new incision may be longer or shorter than the original scar. Your dermatologist or plastic surgeon will be able to provide you with more information about what to expect from scar revision surgery, including the length and placement of the new incision.
In addition to surgery, other treatments that may be used to improve the appearance of scars include laser therapy, chemical peels, and injectable fillers. These treatments can be used to smooth and soften the scar tissue, reduce redness and discoloration, and improve the overall texture and tone of the skin. Again, your dermatologist or plastic surgeon will be able to advise you on the best course of action based on your individual needs and goals.
It's important to note that scar improvement takes time and may require multiple treatments, regardless of the chosen treatment option. Additionally, while scar revision surgery can improve the appearance of a scar, it cannot completely eliminate it. Your doctor will be able to provide you with a realistic idea of what kind of results you can expect from any treatment option.

Nelson Lee Novick, MD · Answer

No surprise that the microneedling did not work. Professionally performed microneedling (no need for the expense and added risks of RF), which I have been performing for over twenty-three years, is best reserved for treating any residual superficial, surface irregularities that may persist after a scar has already been properly treated. It is not a very good primary, monotherapy treatment for deeper scars. Expecting microneedling to treat deeper scars is like expecting a hammer to act as a screwdriver; there's nothing inherently wrong with a hammer if it's used for the proper purpose. When a scar is depressed (indented) then subcision (which I have been using successfully since 1995 for all skin types) can be used it elevate and smooth it. Once this is done, then microneedling can be used to improve the surface color and texture of the scar in order to blend it better with the surrounding normal skin. Surgical scar revision, particularly in areas subject to a great deal of static tension or movement, has the potential for resulting in stretch scar formation and even in tram track stitch marks. You would be wise to consult with an experienced, board certified cosmetic dermatologist.

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