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Indented Box Scar Nose - What Is The Solution

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I feel like all my researching is just going in circles so it's time to make a post.

I have a fairly deep box/rolling scar on my nose. I believe it was the result of a blackhead that was extracted as well as sun exposure and peeling that I assisted. I've had so much acne in my life and did the accutane bit successfully. Now, years later, I am faced with permanent scarring when acne isn't generally a big issue for me anymore :(

So what is the solution? I have been exfoliating with a Biore blackhead scrub once a week and I've been using my leftover Differin, albeit expired, nightly (I'll admit I should probably get new Retin A or Differin before I decide whether it works or not)... I've even made it a habit to use pure honey and sometimes a paste with turmeric powder. I cleanse with cetaphil. No real success as of yet, seems worse on day like today where my nose has been punished with treatments. I know not to overdo it but is there something to be said about it looking worse before it looks better after scrubs? I like to believe it brings you back to your new foundation and then in a week or so when redness is gone & nutrients are restored you can actually see if there is improvement.

A couple of times I had a scab (probably sun induced) form over and flake off.. I legitimately thought both times that the indented scar was gone because it was! A few days later I looked in the mirror again and it was back to what it was, an indented scar. Weird. I've heard of the sun being the solution for some but you can't mix it with other treatments/chemicals (makes you more sensitive to the sun, not good). It seems like I need to keep burning my nose in sunlight while the epidermis is not depleted of it's natural qualities?

What else can I do?

I feel like trying single needling with 1.5mm and aloe vera would be the most promising place to start but there's also;

Personal Microdermabrasion kits

Chemical Peel

TCA Cross

MSM Creme

Love to hear if others have any opinions on the topic of indented scars on the nose (ice pick, box, rolling)

Edited by louiedowntown
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I did a lot of research on scars and from what I understand the skin on the nose is very delicate and is easily scarred so be careful. The skin on that area heals very slowly which is why you're more likely to scar there. I'd go to a professional. NO DERMAROLLING the nose! It could scar. The nose will not heal properly. I know from experience AND from everything I've read (a little too late in my case).

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Hi. Got nose scars before. Tried tca but made it worse. I finally got the courage to needle it using the thinnest diabetic lancet I found. I actually had 4 different needles and the single needle I bought from a well known Pharmacy in our city aas the thinnest in diameter. Do not prick deep, needle sides and try pricking once for the fisrt time. Gradually increase number of pricks if youve got good results. :)

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So thus far I've seen improvements that may only have been temporary... They could just be due to micro-swelling but the solution is a slow and tricky process anyway! From what I've read, 90% of any healing that will take place happens in the first 6 months of a new scar (mine is maybe 4 months old), with the majority of the other 10% not completing until 2 years after.

I've had a somewhat regular (once every 3 weeks or so) single needling sessions with a diabetic needle. It has more length than needed (2.5 - 3mm) so I have to be careful, usually going until the scene is too bloody to work with (maybe 12 pricks if lucky). Prior I will have a warm shower and use a biore pore scrub (not too vigorous). I do one controversial thing immediately after needling and I am not advising anyone to try anything I do. I use earwax remover (which has a weak acid in it, I normally use it for cleaning blackhead dirt out of pores) that causes a slight temporary frosting on the needle site similar to what those THC Peels do, I believe it further activates the injury/healing process.

After this, manuka honey, aloe vera butter, and polysporin are my best friends for a few days. and I try to take 3 MSM pills orally per day with food.

I try not to use the MSM topical cream for a few days because there are too many ingredients in it including stearic acid and vitamin A. But after I am back to MSM cream, Retinol Renewal Night cream and Differin. If I am to clean my face I have Cetaphil with lukewarm to warm water. After a week or so I will go in the steam room. The scar looks odd after doing so but I also feel it becomes super stimulated and will be more absorbent to important topicals like Retin A.

I also now make sure not to needle the good skin, just the scar itself. Maybe this needling process extends the healing time frame so it is crucial to find what works and add nothing to the healing environment that doesn't asap. Read ingredients!

This site has good tips for pre and post needling treatment. I think that hot showers initially burn away the developing skin/scab so I am going to change some habits. I've also seen good results with castor oil and if I get any scabbing it's my favorite thing to put on it. I am interesting in adding copper peptides, vit C serum, and rose hip seed oil to the mix. I'll also note that I take multivitamins everyday and try to drink a lot of water. Exercise is very important!

Things I have noticed:

I can see the pore holes again, this scar seems to be 2 scarred pores and I think I've seen a low bridge forming in between as to separate them again. This appears to have went away but it could just be the surrounding skin rising? It seems to be more smoothed out now. Also with the needling i can't feel it as much near the surface, allowing me to go deeper?

I don't expect this scar to go away but I'll take any improvement I can get. Most likely it will be minimal but who knows, maybe I'll find that winning combination.

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Just an update after another needling session. I did not do the frosting procedure this time, I'm curious to see if there is a difference in scabbing. Manuka honey is the best, redness is the biggest issue after a session and the honey cuts away downtime (site looking crummy deep and red) significantly. I got maybe 20 pricks and was able to go maybe 2.25 mm on some pricks... Soo relatively deep, I know some people say not to needle the nose but the way I see it, skin is skin and I'll just have to be careful. I did feel it puncture through what I thought was the scar tissue and I expect the microswelling/scab formation to come even closer to being flush with surrounding un-scarred skin. . Problem is that even with a little redness you can pinpoint that there is an indented scar, it's all just the relativity like a pothole in the road and having color / shadows being two other distinguishing factor makes it seem exponentially worse and the fact that it looks different on a day to day basis will make you question whether you are getting real results. I just ordered this hyaluronic acid formula. It should be here in time for my next session and I'm pretty optimistic as it has other pro collagen growth ingredients in it (Vit C, Silk peptides, MSM) and a couple others that I think will help. The hyaluronic acid will allow my skin to hold onto 1000x more water. Sounds amazing, I think the adhesive and cohesive properties of water will make it that much more plump, absorbing, and healing. I'm not sure whether it will be best applied immediately or a few days after. The Manuka will probably remain my #1 for immediately after but I still might try the HA formula immediately as the needled sites should help deliver the formula. A trade off might be that there is more redness during the downtime period. It's kind of nice that it's entering winter and I'm doing this as I'll be exposed to a lot less sunlight.

I think I'm seeing results guys, on the nose of all places. I think by next summer this whole needling regime will seem like overkill but this scar thing is pretty complicated so who knows

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I am back with good news. I feel like it's safe to say I am seeing significant improvement though I am always weary of talking too soon. Luckily the nose scars are not tethered so I think the breaking of the scar tissue and reformation is not inhibited by being tethered in scar formation. At some point I will provide pictures. I can still see a large scar when in the worst lighting/angle.

It has been 3 weeks since my last single needling session. I now needle at angles as well as in a straight direction.

Vitamin A is part of my daily life now, orally & topically. Differin (adapalene) AND a Retinol Renewal Cream used at different absorption times are great topicals to use when out of sunlight. There are receptors in the skin that respond to these retinoids and the skin can absorb nutrients the same way it can absorb say LSD. It is my understanding that Vitamin A is able to help cell formation and realigning process as well as to fulfill the cell turnover rate capabilities. SPF 15+ with UVA & UVB protection is a good idea to apply when going out as it can save you from adverse results. Consider this inner and outer treatment with sunscreen being an insurance.

What I've just discovered to make a huge difference is Biore Warming Anti-Blackhead Cleanser. I know there are other exfoliating pore products and I would like to try them but I want to stick to what I know has helped. Hopefully the formula is the same, similar, or better because the product packaging and formula color has changed. Following usage of this is clearer shinier smoother skin, and smaller pores :)... Maybe it is just bringing the surrounding skin to a lower level but after I apply Aloe Vera from a plant, which tightens, reduces redness, and help the healing process further.

I still use the same Hyaluronic Acid formula but much more seldom. Hydration, good diet, and being active are still high priorities. I also believe antioxidants like Acai will only stack on eachother as beneficial. I am taking MSM orally and apply it seldom topically. There are tons of benefits of MSM but the ones I like to hear the most are "boosts collagen production" and "increases permeability" of the skin!

It's a crazy up and down ride (2 steps forward, 1 step back) but I'm finding it to be extremely interesting and good knowledge to have! Fingers are staying crossed and good luck to everyone out there!

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Well Peterpan, forever young lol...  I just went through my 3rd session of a different type of scar therapy.  The indent has been significantly reduced and for that I can say I am happy.  However, I am not out of the woods yet as it is possible I have traded a significant/deep box scar for multiple but less deep scars of a larger area.  Hopefully this area blends into the surrounding skin!  I will report back on my findings soon,  if it does work I have a lot of helpful information to share!  This thing could go either way, fingers crossed!

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On 4/28/2017 at 8:31 AM, louiedowntown said:

Well Peterpan, forever young lol...  I just went through my 3rd session of a different type of scar therapy.  The indent has been significantly reduced and for that I can say I am happy.  However, I am not out of the woods yet as it is possible I have traded a significant/deep box scar for multiple but less deep scars of a larger area.  Hopefully this area blends into the surrounding skin!  I will report back on my findings soon,  if it does work I have a lot of helpful information to share!  This thing could go either way, fingers crossed!

Did you see any improvements? I have an indented scar on my nose and i am thinking to go subcision+ microneedling route on it to make it look better. Would love to know how needling went for you. 
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Hi all, 

About 3 months ago I obtained an indented scar on my nose tip (see pic attached)

I had the following treatments:

  • Single needling x4: didn't work at all
  • Saline injections x5: didn't work at all
  • Scar revision with scalpel: about 20-30% improvement
  • LED light therapy: probably no effect
  • Subcision: First treatment about 30% improvement. Second treatment was a couple of days ago. Will report on the final results.



On 31/7/2015 at 3:16 AM, Factoid said:

Needling and TCA CROSS, subcision if you're brave enough. You'll probably bleed like crazy though.


Avoid the sun as much as possible, it degrades collagen, which is exactly the opposite of what you want right now.



I think TCA cross would be more appropriate for ice pick scars.

Subcision is best reserved for box scars and rolling scars.

There is this guy dr. Novick in NYC who regularly performs subcision on the nose.
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For some reason a scab formed on top and around my subcised nose tip scar. I figured that it was due to the several incision points that were made around the scar which eventually formed a big scab over it. I couldn't resist to remove the scab today, which was a mistake as then I noticed it was also attached to the subcised scar itself. I am not sure how that happened. I suppose a small incision point was made in the scar itself or more likely one of the incisions from around the scar made a small opening directly from below the scar.

Anyhow, there's probably a bit of swelling but not that much at all. There's not that much redness either which is surprising as there was considerably more redness and swelling with my first subcision.

As for the improvement, I'd sincerely rate it at 70-80% but I know it's still too early to tell. It's been only three days after all. It definitely looks a Lot better than at any point after my first subcision, when I obtained roughly 30% improvement. I regret taking off the scab as that will probably conspire against a better result.

Edited by abraxas21
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I've had several liquid nitrogen treatments, probably 5 total. My doctor had terrible aim and so I think I could have done it better on my own. The wart remover is not liquid nitrogen but could have the same effect if you want to do it yourself. The downside is that the pigmentation might be permanently altered (some hyperpigmentation for now, and potentially permanent white spot for later). I just saw a specialist and she says no more liquid nitrogen (which I was finished with anyway and agree). She is insisting on a radio frequency laser in a few more months or possibly a diamond dermabrasion machine.  In the meantime, let it continue to heal naturally, sunscreen, and it is safe to use a derma-pen (not roll because I don't want to damage the surrounding "good skin". Significant improvements have been made but still a ways to go :/

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