Revision of a depressed scar across a relaxed skin tension line by punch elevation, filler injection, and fractional CO₂ laser.

Revision of a depressed scar is more challenging because it does not follow the relaxed skin tension line (RSTL). Several measures have been suggested for revision of this type of scar, and they have a number of limitations, complications, advantages, and disadvantages. A 45-year-old woman presented with a depressed scar measuring approximately 45 × 2.5 mm across the chin area as a result of an accidental sharp trauma 17 years previously. She was subjected to several procedures to revise the scar, but none of them were satisfactory. In our method, multiple punches were created along the depressed scar after performing local anesthesia. Then the punched area was treated with fractional CO₂ laser, and hyaluronic acid was finally injected into the treated area. Significant improvement was seen in the depressed scar during the 12-month postoperative follow-up. The advantages of our method are an easy and quick procedure, no need for very advanced equipment, and absence of any incision or downtime. However, a limitation of this procedure is that it is appropriate only for depressed scars with mild to moderate width and depth.