White hypertrophic scar - how can I improve this? (Photo)

Question

I have scarring on my cheek (left worse than right) that looks like hypopigmentation, possible hypertrophic (a bit raised). I've tried microneedling, lasers (halo/bbl/ipl/fractional), chemical peels... I need help this is destroying my self esteem and I can't go anywhere without make up. I looked into camouflage tattoo but I won't ever be able to use actives or get peels etc in the future. The scar is from 2020/2021 after I believe fractional laser done poorly.

Jeffrey H. Spiegel, MD · Answer

In my opinion, other than excimer laser (which may help), it may be worth scar excisions. The widest and largest of the areas could be surgically removed to create a different type of scar that should be harder to see.

Anna Chacon, MD, FAAD · Answer

I’m really sorry you’re dealing with this. Facial scarring can have a huge emotional impact, especially when it affects your confidence to the point that you feel you can’t leave the house without makeup. The fact that you’ve already tried microneedling, Halo, BBL/IPL, fractional lasers, and chemical peels tells me you’ve been working very hard to improve this, and I can understand how discouraging it is not to see the results you were hoping for.

Based on your description and the photo, this does sound less like simple discoloration and more like a hypopigmented hypertrophic scar — meaning there may be two separate components:

Texture: slightly raised or thickened scar tissue
Color: loss of normal pigment (the white appearance)

That distinction is important because treatments that improve texture do not always restore pigment, which is why repeated resurfacing procedures may have provided limited benefit.

Why Additional Aggressive Laser Treatments May Not Be the Best Next Step

If the scar developed after a fractional laser treatment in 2020–2021, I would be cautious about continuing aggressive ablative or fractional resurfacing in the same area. Once a scar has become hypopigmented, repeated resurfacing can sometimes worsen the contrast by affecting the remaining melanocytes (pigment-producing cells).

What I Would Consider Instead
1. Treat the Raised Component First

If the scar is truly slightly elevated, the treatment with the strongest evidence is often:

Intralesional corticosteroid injections (Kenalog)
Sometimes combined with 5-fluorouracil (5-FU) for more resistant hypertrophic scars

These injections can gradually flatten and soften the scar without further removing skin.

2. For the White (Hypopigmented) Color

This is usually the most challenging part. Options that may help include:

308-nm excimer laser (commonly used for vitiligo and localized hypopigmentation)
Microneedling combined with topical tacrolimus or bimatoprost (limited but promising evidence in some cases)
Fractional non-ablative laser with targeted pigment stimulation rather than resurfacing
Medical tattooing/camouflage as a later option if the scar has been completely stable for a long time
About Camouflage Tattooing

You’re correct that this is a significant decision. The good news is that having camouflage tattooing does not necessarily mean you can never use skincare actives again. Many patients can still use retinoids, azelaic acid, vitamin C, and even certain superficial peels once the tattoo has fully healed. However, medium-depth or aggressive resurfacing procedures could alter the tattoo color, so it’s wise that you’re thinking carefully before pursuing it.

One Thing That Stands Out

You mentioned that the left side is worse than the right. When laser-induced scarring is asymmetric, I often think about:

Different laser energy settings
Uneven overlap during treatment
Variable healing or inflammation afterward
Pressure or trauma to one side during recovery

That history makes me more suspicious that this is a true post-procedural scar change rather than a primary pigment disorder such as vitiligo.

A More Realistic Goal

Because this scar is 5–6 years old, I would be cautious about expecting it to completely disappear. However, many patients with similar scars can achieve meaningful improvement by focusing on three goals simultaneously:

Flatten the scar
Reduce the sharp white-to-normal skin contrast
Improve overall skin blending rather than trying to erase the scar entirely
My Honest Impression

From what you’ve described, I suspect the reason you haven’t improved substantially is that the treatments you’ve had were aimed primarily at resurfacing, while the scar now behaves more like a stable hypopigmented hypertrophic scar. In that situation, I would shift away from repeated aggressive lasers and toward scar-modulating therapy (steroid/5-FU if raised) plus pigment-restoration approaches such as excimer laser or targeted repigmentation treatments.

Most importantly, please know that the distress you’re feeling is completely valid. I’ve treated many patients whose scars affected their self-esteem far more than other people realized, and even when a scar cannot be made completely invisible, there are often still options to make it much less noticeable and easier to live with day to day.

Laser Skin Solutions - Portland · Answer

Dealing with long-standing facial scarring, texture changes, and hypopigmentation&mdash;especially following previous laser complications&mdash;can be profoundly frustrating and exhausting. When multiple aggressive modalities like traditional fractionated lasers, chemical peels, and standard microneedling have already been trialed without the desired resolution, shifting the strategy from aggressive resurfacing to structural dermal remodeling and regenerative healing is often necessary.
As a licensed advanced aesthetician in Portland, I frequently consult with patients who have sensitive, compromised skin barriers and stubborn atrophic or hypertrophic changes. Here is a clinical perspective on how to approach your situation safely:
Evaluating Scar Depth and Tissue Quality: Raised or hypertrophic areas combined with textural depression require careful differentiation. If previous fractional treatments led to poor healing or altered melanocyte function (resulting in the white, hypopigmented appearance), avoiding high-heat or overly aggressive ablative lasers is wise to prevent further thermal trauma to already compromised tissue.
Targeting Dermal Remodeling with RF Microneedling & PRF: To rebuild lost structural volume and soften rigid scar margins without causing further thermal damage, combining Radiofrequency (RF) Microneedling with Platelet-Rich Fibrin (PRF) is often an exceptional clinical choice. The fractional micro-needles deliver precise thermal energy deep into the dermis to break up fibrotic scar tissue and stimulate collagen production, while the growth factors and stem cell alternatives within the PRF accelerate tissue repair, support melanocyte health, and enhance overall healing in compromised skin.
Managing Expectations Around Camouflage vs. Repair: While camouflage tattooing is a permanent commitment that can restrict future clinical treatments like active chemical peels, semi-permanent or medical-grade mineral correctors can offer daily psychological relief while your skin barrier continues to heal.
Before considering any new intervention, it is vital to work closely with a clinical professional who can perform a thorough diagnostic assessment of your tissue thickness and barrier integrity to build a custom, low-risk restoration plan.

White hypertrophic scar - how can I improve this? (Photo)

Answers (3)

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