Please advise on treatment for laser burn scar on nose crease after spider vein removal (Photo)

Question

I had laser treatment done on my nose for spider veins but was left with a crusted scab that turned into an indented scar on the crease of my nose. I am wondering if anything can be done for this indentation scar after I was burnt. I did everything I was told to do and even followed up with the clinic that did it to assure I took care of it properly. Please advise on how I can make it look better. It’s been over a year now.

Nelson Lee Novick, MD · Answer

Subcision, which so many people mistakenly believe is used exclusively to elevate and smooth acne scars, can be used to elevate and smooth indented (atrophic) scars from all causes, including post-surgery, post-injection, post-trauma, and post scarring infections, such as chickenpox. I have been routinely performing subcisions for all these causes since 1995 with very gratifying results. You would be wise to consult with an experienced, board certified cosmetic dermatologist. I have been alerting my regular follower for years to exercise a great deal of "buyer beware" caution when considering expensive lasers and other "here-today-gone-tomorrow" devices with fancy, alluring names, since the hard science to back up the inflated claims for these gizmos lags woefully behind the heavy social media and marketing hype to promote their use. Going forward, for the inevitable appearance of new "broken capillaries" and spider veins on the nose and face, consider short wave diathermy--i.e. the use of a tiny electric current discharged into the unwanted capillaries via a hair-thin probe placed at the surface of the skin above the vessel. This procedure, unlike lasers, has been used successfully for this purpose for decades with very gratifying results. I typically give my patients a mirror so they can watch the blood vessels disappear right before their eyes as I treat them.  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

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