Can My Leg Scar Be Improved With Laser Resurfacing and Steroid Injections?

Q: Dr. Eppley, One year ago I decided to do laser skin resurfacing in order to get rid of small scars on my leg. They were scars after ingrown hair. I did the last procedure one month ago and the result just scares me. I think that they burned me. It was Cutera Fraxel Laser.They also made a cortisone shot to my scars and didn’t tell me about the possible side effects. Now my skin is a little bit recessed. Now I’m so scared. I do not know what to do. Is that possible for skin to recover after cortisone shot? Is that possible to do a scar revision? Thank you in advance and kind regards.

A: While fractional laser resurfacing can offer improvement for some scars, legs scars from ingrown hairs would not be one of them in my experience. All laser resurfacing  methods basically create a superficial burn, allowing secondary healing and re-epitheliazation to take place. In essence, ‘burning you’ is how the laser works. Fractional laser resurfacing simply burns less of you, hence the term of a fraction of the skin’s surface. But each laser column goes deeper, actually creates a deeper burn injury (but less of it) in the hope of promoting improved collaguen remodeling. While this frequently offers scar appearance improvement in the face, it is less successful below the neck. The thicker and less forgiving leg skin is always risky when it comes to any type of scar revision. It is easier to burn and heals more slowly. It is more prone to hyperpigmentation even after  it is healed.

Another misconception is that of ‘getting rid of scars’ with laser resurfacing. It simply does not work that way. It is not as simple as using the laser like a blackboard eraser. At best, it is about some level of scar improvement. When comparing the risks vs benefits in laser resurfacing of leg scars, you are unfortunately experiencing the very narrow margin between improvement and the risk of further s potential scarring.

Depending upon the dose, steroid injections can cause subcutaneous fat atrophy and even skin thinning, thus the indentation that you are seeing. If this was a single dose, and it appears that it was, then there is a good chance of rebound fat restoration over the next few months. You will not know fully until six months after this injection. No further steroid injections should be done. They do not help the healing of any burn injury and can actually cause other potential problems as you have now know. Patience and further healing is the key to now allowing this scar area to settle and judge the final result.

Dr. Barry Eppley
Indianapolis, Indiana