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CuriousNYC

Intramarginal excision

Hi! I’ve been reading this forum for a while and really respect the experiences of the posters here. I’m hoping to get your perspective on my scar situation, even though it’s not directly related to acne. Here it is:
 
A dermatologist performed a shave biopsy on a suspicious mole on my cheek (which was inflamed due to acne) and instead of superficially grazing the top layers of skin, she scooped downward and caused serious damage. The wound took five months to heal. I generally have good skin - just some very light acne scarring in a couple places - but after this fine doctor’s biopsy, I have a 4mm x 6mm crater scar in the middle of my cheek. 
 
This happened a couple years ago, so I’ve had a chance to let time improve the scar. I’ve also tried CO2 laser resurfacing (which I think made it wider) and fillers. The scar is only slightly depressed, but its poor texture and color, and its width, make it appear to be more depressed than it is in some lighting. I am very self-conscious about it.
 
I’ve met with nearly 10 plastic surgeons and dermatologists, all of whom seem to have different recommendations (fillers, lasers, microneedling, subcision, excision, leave it be). I recently talked with an accomplished dermatologic surgeon who recommended an intramarginal, 2-stage excision — cutting out the center of the scar in an elliptical shape, stitching it up, and then cutting out the remaining bit of scar tissue in elliptical shape six weeks later. This actually makes the most sense to me of all the options I’ve heard, and even though it would result in a short linear scar I’d be OK with that. 
 
However, after reading about many failed excisions, I am terrified of making the wrong choice and creating a worse situation than what I have now. I’ve read that excision scars spread open - within days or sometimes months/years later. Why do you think some excisions succeed and some fail? Has anyone here done an intramarginal excision?  Any input would be greatly appreciated!!

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@CuriousNYC I cannot give full advice as I have not sceen the scar, like the various doctors you consulted with, who were also able to observe it in animation / movement. From your treatment history of CO2 laser and filler with nothing getting better, either the doctors treatment was bad or you were expecting a different result than what it provides. Even acne scar suffers never get truly perfect skin, it is softened and made more acceptable after sometimes 2 years of various treatments.

If you have been to 10 plastic surgeons and derms, they will all have various ways to treat your issue, depending on what they specialize in and are good at. Your questions when consulting with them should be what experience do you have treating scars like mine and how many have yuo done. Then of course asking to see pictures.  4 x 6mm is pretty small. This should be handled by filler and laser treatments. If thees did not work or you did not have enough (yes laser widens and soften the scars).

Why was TCA cross never tired to raise the scar bed?

I do think your best bet is a geometric or z  closure of the scar (depending on how the skin pulls). This is typically done by a PS during scar revision. A tiny line is left and lasered for further reduction in appearance. This is probably your best bet at this point. Ask to see pictures of similar scar revisions and choose someone with the most experience.

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Thanks for your response, @beautifulambition! Let me clarify: the CO2 laser did help in the sense that it made the scar more shallow, but in doing so it also widened it. It seems to take up more space now. 

The biggest issue is the texture--the scar just doesn't look like regular skin, so I have a circle/oval of scar tissue in the middle of my cheek. Even if I lifted the base with TCA Cross or fillers or subcision, the top layer doesn't look right. Here is a photo. I feel like a well-performed excision could result in a much neater outcome.

Edited by CuriousNYC

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@CuriousNYC You look better than like 90% of the scar suffers on this site, one tiny imperfection which adds character. All that facial hair as well. 
 
Do what you feel is best if it's scar revision do that. If it was me I would just do subcision, filler and tca the skins surface a few times. It's really not that bad.

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