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carriesaredhandbag

Please help with acne scar that's both raised and indented (photos)

Posted (edited)

Hi - long-time reader, first-time poster here. 

Sorry this is a bit long (TL;DR at the bottom); probably easiest if I post in bullet points...

  •  Picked at a cystic spot on the bridge of my nose in September 2018; it became indented and raised up around the edges
  • (Stupidly) had laser treatment (CO2 fractionated, apparently 'soft' settings) in December 2018 to smooth out the raised part, and it healed very slowly/messily
  • Ended up with lots of ?milia ?closed comedones after laser (not sure if due to laser itself/steroid cream prescribed by derm post-laser/vaseline as an occlusive while healing)
  • Had some of the milia/CCs extracted in February 2019; they came back, I picked at them and made more (small) scars and lots of fine lines
  • Most milia/CCs now seem to have gone away, but there is a cluster of them in/around the scar itself, which seem to be contributing to the 'raised up' look. I think there is also some actual hypertrophy contributing to the raised up part

I've been on tretinoin 0.025% for the last couple of months to try to extract those little bumps/smooth out the fine lines, and nothing has really happened. The area is still raised up, and doesn't seem to be getting flatter. I haven't been able to take the best photos to really represent how bad it looks, but the light bounces off it something crazy, and the surrounding skin texture is awful close up (due to the bumps and the picking leaving little holes/wrinkles). The actual indented part is small and actually fairly shallow - what looks awful is the surrounding area.

I'm wondering what my options are?

I absolutely can't go for laser again - it made everything worse the first time around, and the downtime (a month before I could even put makeup on) was awful. So do I..

  • See if I can find someone to do a steroid injection for the raised up part (obviously with the risk of more atrophy)?
  • Persevere with tretinoin (no higher doses than 0.025% in my country) to see if that clears the CCs and helps the overall appearance?
  • One plastic surgeon (who I'm due to meet next week) suggested subcision/fat droplet transfer based on the photos, but I'm worried that (if successful) would just fix the dent but won't fix the raised up part/CCs.
  • I half want to get the whole thing excised and closed to make a flat linear scar, but worried about the risk of making it even worse. I've tried the TO AHA/BHA 30%/2% peel at home a couple of times, to no avail. I'm getting quite desperate.

TL;DR - I have an atrophic acne scar on bridge of nose that's raised up around the edges. There are several deep milia/CCs/wrinkles in the surrounding area making everything look worse. I want to get rid of the raised up part/textural issues more than the dent itself. What can I do?

Photos below don't look nearly as bad as it does 'in the flesh'. In the third photo, I've drawn a dotted line around the raised up part so you can see how much bigger it is than the dent itself.

I'll be so grateful for any help anyone can give. 

 

IMG_9765.jpg

IMG_9830_1.jpg

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IMG_9840.jpg

IMG_9849.jpg

IMG_9864 (1).jpg

Edited by carriesaredhandbag
Added more info to title

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@carriesaredhandbag 

Hi there, ... wow long post ;-)

Steriods - vaseline cause millia, sounds like your a slow healer, millia are hard to treat they are genetic and a benign cancer tons of people have. A pocket of sebum. I don't see millia, I see a box car on the bridge of your nose. That is really the only issue I see with your skin. Everyone has large pores, some fine lines, and we all age.  This area is hard to treat because of anatomy and danger there.

Botox is the very first thing I would do. This will soften the scar and prevent movement.

Have the Dr subcise even if it's with a normal needle the scar (may take a few times), they can do saline injections if you need as filler is tricky here.

Some do dermastamping at home on the box car, especially the border, and others get prp and needling done at a clinic. With your sensitivities tell the Dr and avoid harsh oclusives or skin care products. If you don't heal well only have them treat the edge of the scar or you can do it at home, not the face.

.25% is pretty low for a retinoid, bump it up if you can handle it.

Look into peels that can dissolve the excess sebum. There are a ton of ones at the spa's. Or something like salicylic at home. Some Dr's use co2 laser to treat Milia. For large pores and textural issues 1927nm 22 pass fraxel is extremly popular. 

RF needling is also good to shrink pores and work on that box car.

You can do monthly alternating at home dermastamping around the scar (or derminator single needle attachment to the scar walls), and glycolic or salicylic peels at home. Between Dr's treatments. 

Skin boosters are also very very popular for this type of thing injected into the smaller surface scars. 

Without down time your very limited, all treatments require this and the greatest ones have down time. So perhaps botox, stamping and treat at home. RF needling isn't bad and can have makeup over it. 

If you have tried peels a few times, your peels are not strong enough, your not using the right technique or heal poorly. 

Go with the plastic surgeon possibly or consult 2 other Dr's and pick the one you like best. 

I am limited by the constraints you gave me, ... I think you should pick a practitioner that you like best and try some manual methods first. As you don't like laser. 

 

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Posted (edited)
1 hour ago, beautifulambition said:

@carriesaredhandbag 

Hi there, ... wow long post ;-)

Steriods - vaseline cause millia, sounds like your a slow healer, millia are hard to treat they are genetic and a benign cancer tons of people have. A pocket of sebum. I don't see millia, I see a box car on the bridge of your nose. That is really the only issue I see with your skin. Everyone has large pores, some fine lines, and we all age.  This area is hard to treat because of anatomy and danger there.

Botox is the very first thing I would do. This will soften the scar and prevent movement.

Have the Dr subcise even if it's with a normal needle the scar (may take a few times), they can do saline injections if you need as filler is tricky here.

Some do dermastamping at home on the box car, especially the border, and others get prp and needling done at a clinic. With your sensitivities tell the Dr and avoid harsh oclusives or skin care products. If you don't heal well only have them treat the edge of the scar or you can do it at home, not the face.

.25% is pretty low for a retinoid, bump it up if you can handle it.

Look into peels that can dissolve the excess sebum. There are a ton of ones at the spa's. Or something like salicylic at home. Some Dr's use co2 laser to treat Milia. For large pores and textural issues 1927nm 22 pass fraxel is extremly popular. 

RF needling is also good to shrink pores and work on that box car.

You can do monthly alternating at home dermastamping around the scar (or derminator single needle attachment to the scar walls), and glycolic or salicylic peels at home. Between Dr's treatments. 

Skin boosters are also very very popular for this type of thing injected into the smaller surface scars. 

Without down time your very limited, all treatments require this and the greatest ones have down time. So perhaps botox, stamping and treat at home. RF needling isn't bad and can have makeup over it. 

If you have tried peels a few times, your peels are not strong enough, your not using the right technique or heal poorly. 

Go with the plastic surgeon possibly or consult 2 other Dr's and pick the one you like best. 

I am limited by the constraints you gave me, ... I think you should pick a practitioner that you like best and try some manual methods first. As you don't like laser. 

 

@beautifulambition

You are an absolute hero for this, thankyou so much for taking the time. As mentioned, I've been lurking forever without signing up, and have been super impressed with your knowledge and care! And I think you're right - I am a slow-healer.

The issue for me with the little bumps (which I couldn't capture in the picture) and fine lines is that they weren't there before any of this - before I stupidly picked that spot, I had fairly clear line-free skin! I'm really grateful for your suggestions - sounds like maybe I could go with that subcision/filler first, and then look into RF microneedling and peels etc afterwards? 

I am seeing another surgeon a few weeks after the first as I wanted to make sure they didn't totally contradict each other, so thanks for the validation on that too (I feel like I must seem like a mad person seeking so many opinions). I'd love to bump up the tret; I've ordered some from an (allegedly reliable) overseas pharmacy as nothing higher than 0.025% is available in the UK, but will obviously patch test a few times before I try it for real. 

Last thing, if you have the time to spare: below is a photo I took two days after the original laser treatment in December 2018. As you can see, I've come a long way since then, but does it look like a normal laser reaction to you? It basically ended up like quite a pronounced gouge (second pic) with raised edges for 4-6 weeks after I had the laser done. No worries if you don't have time, but just interested to see what your opinion is.

Thankyou again, very much. :)

IMG_5615.jpg

Dec 15th (3).PNG

Edited by carriesaredhandbag
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@carriesaredhandbag Welcome!

This could be caused by a combo of damage and or steroids. Do not exfoliate it. 

They might be prone to excise it if they are a plastic as I said above, ... botox is necessary regardless of what you do. You don't want to move while healing.

You have come a long way from the below pics, it's a large boxcar.

They could co2 laser the edges to soften them. A bit of filler may help as well and some subcision, if they will do it here, many won't so you will have to prp, saline, and or Chinese cupping amazon.

I am afraid about your healing capability, so subcision sounds good to start with. 

Wear a silicone scar patch if you need after any surgery. 

It looks like a laser reaction from someone who did not know what they were doing, and caused damage or it healed poorly. I would have treated the edge of the scar not the middle. 

- BA

 

 

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If someone would tell me now that I have BDD I would laugh) here the classic case of BDD. 

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1 hour ago, Sibel said:

If someone would tell me now that I have BDD I would laugh) here the classic case of BDD. 

What is bdd ?

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1 hour ago, Sibel said:

Body Dysmorphic Disorder.

I am Sorry but what is it ? What it means ?

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Posted (edited)

A mental condition with the obsessive focus on a perceived flaw in appearance, could be minor but the person spends days and years trying to fix it staying obsessed by it. All scared people have it to some extent. In some cases severe where the person can not leave the house because of one scar, some live more or less ok but obsessed with pictures in different light, some can not stop with the treatments... I have it too. Looking at the author scar.. Looking at mine 20+ scars on the forehead.. 

Edited by Sibel

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On 7/7/2019 at 6:36 PM, beautifulambition said:

@carriesaredhandbag Welcome!

This could be caused by a combo of damage and or steroids. Do not exfoliate it. 

They might be prone to excise it if they are a plastic as I said above, ... botox is necessary regardless of what you do. You don't want to move while healing.

You have come a long way from the below pics, it's a large boxcar.

They could co2 laser the edges to soften them. A bit of filler may help as well and some subcision, if they will do it here, many won't so you will have to prp, saline, and or Chinese cupping amazon.

I am afraid about your healing capability, so subcision sounds good to start with. 

Wear a silicone scar patch if you need after any surgery. 

It looks like a laser reaction from someone who did not know what they were doing, and caused damage or it healed poorly. I would have treated the edge of the scar not the middle. 

- BA

@beautifulambition

Thankyou again for getting back to me. I won't name the consultant dermatologist who did the laser openly, but it was someone who is meant to be extremely skilled with laser. Clearly wasn't to be in my case! 

I've made an appointment with Mr Chris Abela and Dr Sorensen (both London plastic surgeons) who fortunately offer lots of different treatments options so should hopefully be able to work out a combination plan like you've suggested.

Thanks again, so much. :)

23 hours ago, Sibel said:

A mental condition with the obsessive focus on a perceived flaw in appearance, could be minor but the person spends days and years trying to fix it staying obsessed by it. All scared people have it to some extent. In some cases severe where the person can not leave the house because of one scar, some live more or less ok but obsessed with pictures in different light, some can not stop with the treatments... I have it too. Looking at the author scar.. Looking at mine 20+ scars on the forehead.. 

I have wondered about BDD, and I know it's natural for scars to look much worse to the person they belong to but, as mentioned, it is a lot more noticeable and the texture is pretty horrible in person (and especially in harsh electric lighting).

I should also point out that these are the first photos I've taken in about six months (since not long after the original laser treatment), so definitely not obsessed with pictures in different light. I only took these to give as good a view as I could of the area, albeit unsuccessfully on my phone camera.

I've tried and tried to ignore it, and would be able to if it were somewhere less prominent (I have much bigger scars in less conspicuous places that I completely ignore). But I've been miserable about it for 10 months now and I need to do something about it.

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Posted (edited)

@carriesaredhandbag, just wanted to say that your scarring is not noticeable at all from your original photos and you've healed really well since that laser experience.

Interested to know what you are thinking of having done next? I'm in London too and not heard of those doctors you mentioned.

Still deliberating over DermaPen for my shallow boxcar (also forehead) and hoping Tretinoin begins to do something.

Edited by jwebs91

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Posted (edited)

@jwebs91 - Thankyou, that's really kind! It's always worse when it's on your own face isn't it? I wish I could have captured the texture - when I look at it in my own mirror at home, there's still quite a clear demarcation line between the normal skin and the part that was treated by the laser, along with a bunch of lines and dents (only there) that I never had before. :/ I know it's quite small in the grand scheme of things, but if I could make it a bit neater/sort out the texture and raised up area, I wouldn't even be that bothered by the dent itself. 

Chris Abela and Jesper Sorensen are both plastic surgeons so do a lot of surgical scar revisions. Both also do microneedling, botox, laser (though never doing that again!), filler and peels. I'm thinking about botox as BA suggested, and then either subcision/filler or microneedling (or both) depending on what the surgeons recommend. I'm not averse to a peel, but more optimistic about the other options. 

Dr Sorensen had to cancel my appointment last week due to unforeseen circumstances but have rescheduled for August. I'm seeing Mr Abela at the end of this month. Have you posted a picture of yours? BA always seems to give fantastic advice - might have a few suggestions as to whether microneedling is your best option or not? :) 

 

Edit: Just had a look at your post about your scar, and I genuinely had to look very hard to find the area you were talking about. I do see it (just about!); I understand how much it will naturally bother you because it's your own skin, and how hard it is to take an accurate picture! But honestly, if those photos are at all an accurate representation of your skin, there is zero way I would ever have noticed without you explicitly pointing it out, I promise!

Edited by carriesaredhandbag

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