Dear Dr. Lam,
I greatly appeciate the understanding and compassion you show by taking the time to share your tremendous wealth of knowledge and expertise! I'm a middle age white male and my biggest concern about my atrophic "1/2 wide by "3/4 high U shaped scar from a skin flap, following Mohs for BCC, that is centered on the bridge of my nose is the soft, shallow and gradual horizontal half moon shaped depression at the bottom. It looks bad outdoors and in the shadows casted by certain lighting. Presumably, the mild vertical line incision scars, which are more sharply but less depressed, could be fine tuned and plumped up with a fractional laser in skilled hands, or would you say that this collagen stimulating laser can't be pinpointed precisely enough? Additionally, I've been told that this treatment wouldn't stimulate enough collagen to fill in the horizontal contour deformity that is not much deeper than "1/16. Do you agree or do you think it really depends on the skill of the doctor?
Of course, I would prefer to avoid another surgery. However, is another shorter flap pulled up from below a good option despite virtually no horizontal scar texture issues and the long healing process that would follow? I also have a "1/2 long moderately deep atrophic childhood scar between my eyes that I would like to have surgically revised. Perhaps some fat could be harvested from there and injected into the depression below or would you recommend another filler instead and if so which one(s) would work best? I live in another state so for this and other reasons I would really prefer a permanent correction but the best possible result is my first priority.
Another factor to consider is that this U shaped "trapdoor" scar is apparently adhereing to the underlying tissue. So can and should these adhesions be broken up with saline injections or something else first perhaps? Or would self massage be effective on this 2 plus year old scar?
Of course, I understand that your answers are sight unseen and based on my subjective description. Regardless, I greatly value your opinion as the foremost authority on this subject. Please reply. Thank you very much!