How to improve facial scar cheek from childhood? (photos)

Question

Hi I am south Asian I had a scar on cheek from childhood then I went into revision but another scar formed , I did profractional laser (3 years later the scar revision ) and micro needling by a tattoo artist which made it red and only after makeup it goes back to the original irregular texture What can I do to get rid of the scar ? Will filler help please advice

Nelson Lee Novick, MD · Answer

I share your your frustration with your prior treatments, but I am hardly surprised at their lack of success. For years, I have been cautioning my regular readers that surgical scar revision surgery runs the risk for the subsequent development of stretch scars (and even tram track stitch marks) especially when performed in areas, such as the cheeks, subject to underlying muscular tension or movment (as in this case). I am also not surprised by the lack of success with the fraxel laser treatments. I have long been cautioning my readers that these relatively expensive procedures (much like so many of the "bells and whistles" light and energy-based device treatments), while heavily marketed, are backed far more by social media buzz and advertising hype than any hard science. Once again, sorry. And, while I have been professionally performing manual microneedling (no need for the added expense and risks of RF microneedling) for nearly twenty-five years, it is best reserved as a final "polishing" step to improve residual, surface color and textural irregularities, rather than as a primary treatment for more deeply indented scars. Subcision, on the other hand, which I have been performing since 1995, is a simple and relatively inexpensive technique for elevating and smoothing all kinds of indented scars, whether from surgery, trauma, infection, etc. Furthermore, it can be safely used in all skin types. Once this is done, THEN microneedling needling can be done to improve the scar surface. You would be wise to make sure that you are consulting with an experienced, board certified, cosmetic dermatologist scar specialist. Hope this helps and best of luck.

Jason Emer, MD · Answer

"It's difficult to determine the best solution for you without the benefit of a formal evaluation. Generally speaking, scars can be improved with a combination of surgery and/or lasers and microneedling with PRP. Below is a more detailed reference list of the treatments available. I recommend getting a formal evaluation with a scarring expert to determine which is best for your specific case. 
Options can include:
1. Vascular lasers (BBL, Yellow laser, V-Beam, Excel V) 
2. Fractional lasers (Fraxel, Erbium, CO2, Halo) 
3. Microneedling/PRP 
4. Silicone-based scar gels with growth factors 
5. Excision/revision surgery 
See an expert to develop a treatment plan that works for you. Best, Dr. Emer​"

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

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