Would surgical scar revision be ideal for a 10 year old mole removal scar? (photos)

Question

Almost 10 years ago I had a mole removed from my cheek. Unfortunately, it got infected and I was left with a very wide, deep and irregular scar. The mole is also still visible a little bit (little circle) I have done fractional laser but am not satisfied with the result… I am thinking about doing surgical scar revision. Is that likely to leave a deeper and wider scar? Because my goal would be thinner and less deep…

Nelson Lee Novick, MD · Answer

I am sorry that this has happened to you. It is for this reason that I have been advocating for Scalpel Sculpting for removing moles, even flat ones. Scalpel Sculpting requires no deep surgical cutting and hence no need for the placement of stitches, so that there is no chance for the later development of stretch scars and tram track stitch marks. Sorry.  If revision surgery would be performed, the subsequent development of another stretch scar and stitch mark tracks would be my major concern, especially in an area such as the cheek that is subject to a great deal of movement. 
The lack of success with fraxel lasers is likewise no surprise to me. I have been cautioning my regular followers for many years that the marketing hype and social media buzz for fraxel lasers, much like that for RF devices and other expensive "bells and whistles" gizmos, lags well behind the hard science to support their use. So, sorry again.
Subcision, which I have been performing for nearly thirty years, is a time tested, effective method for elevating and smoothing indented scars from all causes, including prior surgery, as in this case. Once elevated, professionally performed manual microneedling (no need for the added expense and risks of RF microneedling) can be used to better blend the surface of the scar in both color and texture, with the surrounding normal skin. 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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