How to improve 3 month old atrophic fascial scar appearance?

At three months, your atrophic (sunken) fascial scar is still in the early stages of healing, but it’s understandable to want to improve its appearance, especially if it’s visible and causing distress. You’re correct that atrophic scars are challenging because they involve a loss of underlying tissue, not just a surface irregularity.

Non-surgical options to consider:

Subcision:
This minimally invasive procedure uses a fine needle to break up the fibrous bands tethering the scar down, allowing the skin to lift and new collagen to form. Subcision is often very effective for atrophic scars and can be combined with other treatments.

Filler Injections:
Hyaluronic acid fillers can be used to lift sunken scars, though the area and depth must be carefully assessed by an experienced injector. While there is a small risk of complications, especially in areas with thin skin or near important structures, fillers can provide immediate improvement and are reversible.

Microneedling (with or without PRP):
While RF microneedling and CO2 lasers are more effective for texture and superficial scars, traditional microneedling (sometimes combined with platelet-rich plasma) can stimulate collagen and help with mild atrophy, especially when combined with other modalities.

Laser Resurfacing:
Fractional CO2 or erbium lasers are more helpful for texture and color, but when combined with subcision or fillers, they can enhance overall results.

Treatment order and expectations:

Start with subcision if the scar is significantly tethered. This can be repeated every 4–6 weeks as needed.
Consider filler after subcision if there is still a noticeable depression. Results are immediate but temporary (typically 6–12 months for hyaluronic acid fillers).
Microneedling or laser can be added to improve texture and stimulate further collagen production, but these are less effective for deep volume loss alone.
Realistic expectations:
Most patients see a noticeable improvement, but complete correction is rare. Improvement of 40–70% is typical with a combination approach. Scars continue to remodel for up to a year, so some natural improvement may still occur.

Key advice:
Seek a board-certified dermatologist or plastic surgeon with experience in scar revision. A tailored, multi-modal approach often yields the best results.

You might wish to consider simple, relatively inexpensive Subcision, which I have personally been performing for thirty years, to elevate and smooth your scar.
We have known for several decades already that there is a window of time of between the end of week four (after the injury, infection, acne, surgery, etc.) and the end end of week 12 following the aforementioned when there is actually a chance of erasing the imminent scar. Four weeks is when an imminent scar is strong enough to withstand treatment and twelve weeks (when the scar is considered "mature," after which there is usually only a 60-80% chance of overall improvement. So, time would appear to be of the essence here, since three months have just passed. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon