What Type Of Scar Revision Do I Need For My Nose Scars?

Q: I have two surgical pitted crater-like scars on the side of my nose which are really annoying. I have previously tried erbium laser, two courses , nine months apart, and punch excision surgery, but neither treatment helped me. I noticed that your Doc had some impressive photographs of before and after scarring online and would like to know if I can be treated by way of any suggestion the Doc can make. I can send a photograph if you like.

A: The nose is one of the most difficult areas on the face for effective scar revision. The skin of the nose is tight, stretched over bone and cartilage and very thick. This leaves little skin laxity that can close easily after excisional scar revision and skin so thick that even deep laser resurfacing can not smooth out. In looking at your pictures, your two nasal scars are wide and very saucer-shaped. It is a wrong concept to try and bring the surrounding skin down to the level of the scar through any form of laser resurfacing. They are too deep.  It is also not possible to excise them as they are too large and the nose has no skin laxity. What you what to think about is building up the scars from underneath with either cartilage or dermis/dermal grafts. They could be placed underneath the scars through an incision inside the nose. Building up the base of your nose scars is the only approach that will likely make them less noticeable by making their concave contour less so. Your nose scar revision is augmentative in nature.  

Dr. Barry Eppley

Indianapolis, Indiana