Jason Emer, MD, FAAD, FACS
Removing A Hypertrophic Acne Scar With An Advancement Flap: How Dr. Emer Closes The Wound Tension Free
How Dr. Jason Emer removes a raised acne scar and closes the site with an advancement flap, layering dissolvable sutures so the wound heals with no tension and a finer line.
Dr. Jason Emer MD · FAAD · FACS
The practice's own photographs
Patients of the practice, from Dr. Emer's published before and after gallery. Each case is one patient. Individual results vary.
See the full before and after gallery
Every case above is a patient of the practice. Your consultation with Dr. Emer starts with your photographs and your goals.
A hypertrophic acne scar on the face, excised and closed tension free with an advancement flap and layered dissolvable sutures so the wound heals with no tension and a finer line.
Your plan starts with Dr. Emer.
Book online and reserve your time with a card, or call the office. West Hollywood and New York.
From the filmed session
What Dr. Emer did · RE:SKN
Complete removal of the raised scar tissue from cystic acne, leaving healthy tissue on both sides of the wound, performed under local anesthesia with the patient awake.
“We numbed him out pretty well. He's just sitting here relaxed. Doesn't feel anything. Maybe just a little bit of pulling and getting rid of the scar first.”
Dr. Emer, in the film
A flap of surrounding skin raised at the dermal and subdermal depth, using the hair follicles as a guide to preserve the small blood vessels that travel within the dermis, with back cuts to reduce tension.
Deep dissolvable sutures placed in the dermis to hold the tension, followed by fine surface sutures, creating a closure with no tension on the wound edges.
Why patients fly in
The dissolvable sutures are placed deep in the dermis, not just at the surface, and they dissolve slowly over six months so the tissue has time to heal and form a stable scar before the sutures are gone.
“These sutures that we're placing in it, it takes them about six months to completely dissolve and that's more than enough time for everything to be stably healed.”
The advancement flap is raised at the exact depth where the hair follicles sit, because that is where the small blood vessels travel. Too deep and the tissue will not survive; too shallow and the blood supply is compromised.
“You can see the hair follicles is your guides because they live in the dermal subdermal area. So that's where you know your blood flow is.”
Strategic back cuts in the surrounding tissue give the skin expandability so the flap can advance over the wound without pulling on the edges.
“Create some space also call it back cuts. These are gives a little bit of an expandability for the skin. The skin is a very structurable structure. if you know how to manipulate it the right way without damaging vital structures.”
The technique follows the same concept Dr. Emer uses in deep plane facelifts and platysma advancements: fine-scale movements, knowledge of anatomy, and tension-free closure.
“Same thing we do with the facelift guys, you know, with the, you know, the mini facelift or full plane facelift. If you know your anatomy very well and you have the fine touch or the fine scale movements.”
THE THINKING BEHIND THE TREATMENT
Follow Dr. Emer’s approach through the stages described in this case.
Back to the video ↗A raised, thickened scar on the face, removed and closed tension free in one session.
The patient in this video had a hypertrophic scar on his face from cystic acne. There was no injury or trauma. The acne itself became the scar, raised and thickened over time.
“He has some hypertrophy scar tissue on his face. We're trying to get rid of it for him. He got it from cystic acne. There was no trauma or injury or anything like that. It's just the acne itself became a hypertrophied scar.”DR. JASON EMER · FROM THE VIDEO
Excision, flap advancement, layered closure. The patient is awake and numbed throughout.
Dr. Emer numbed the area completely so the patient could sit awake and relaxed during the procedure. He removed the scar tissue, raised a flap of surrounding skin to advance it over the wound, and closed the site in layers with dissolvable sutures placed deep in the dermis so there would be no tension on the edges as it healed.
Visible inflammation and bruising last about one week. The incision is strong enough to return to daily activity after about six weeks, once the deeper layers have healed.
The goal is not to erase the scar entirely. It is to replace a thick, raised scar with a thinner, softer line that sits flat and may become nearly invisible over time.
Excision and advancement flap, closed in layers / Patient story
A raised, thickened scar on the face, removed and closed tension free in one session.
The patient in this video had a hypertrophic scar on his face from cystic acne. There was no injury or trauma. The acne itself became the scar, raised and thickened over time.
Dr. Emer numbed the area completely so the patient could sit awake and relaxed during the procedure. He removed the scar tissue, raised a flap of surrounding skin to advance it over the wound, and closed the site in layers with dissolvable sutures placed deep in the dermis so there would be no tension on the edges as it healed.
Watch the full procedure on YouTube: https://www.youtube.com/watch?v=K55SUjYdGe8
The patient in this video has a hypertrophic scar on his face, raised and thickened from cystic acne. There was no injury or trauma. The acne itself became the scar.
Dr. Emer numbed the area completely so the patient could sit awake and relaxed during the procedure. The goal was to remove the scar tissue and close the wound in a way that would not create tension on the edges, which is what causes a scar to thicken or widen as it heals.
Once the scar tissue was removed, Dr. Emer raised a flap of surrounding skin to advance it over the wound. The depth and thickness of that flap matter: too deep and the tissue will not survive, too shallow and the blood supply is compromised.
He used the hair follicles as a guide, because they sit in the dermal and subdermal layers where the small blood vessels travel. That is where the flap needs to be cut to stay alive and heal cleanly.
How the repair is built
Excision, flap advancement, layered closure. The patient is awake and numbed throughout.
The hypertrophic scar is excised completely, leaving healthy tissue on both sides of the wound.
A flap of surrounding skin is raised at the correct depth to preserve blood flow, using the hair follicles as a guide to stay in the dermal and subdermal layers where the small blood vessels travel.
Dissolvable sutures are placed deep in the dermis first, then the surface is closed with finer sutures. The deep sutures hold the tension so the edges heal flat.
Visible inflammation and bruising last about one week. The incision is strong enough to return to daily activity after about six weeks.
The treatment, explained
Also called advancement flap, scar revision surgery, acne scar removal, surgical scar excision, tension-free closure, layered scar closure.
Ready when you are.
Pick your consultation, reserve it online with a card, and Dr. Emer's team confirms the time. Or call the office.
Signature procedures
Peptides / biologic optimization
Peptide and biologic protocols for recovery, body composition and longevity, with epigenetic testing. RECODEX™ peptides are available to purchase through the practice after consultation.
Why Dr. Emer
Two decades of outcomes in dermatologic and cosmetic surgery, and the precision to know when a scar needs excision, not just resurfacing.
Dr. Emer built his reputation on results that require both dermatologic knowledge and surgical skill. He treats acne scars with lasers, microneedling, fillers and subcision when those tools fit the case, and he performs surgical excision when the scar is raised, thick or hypertrophic and will not respond to surface treatments alone.
Patients come to him when the scar has been there for years, when other treatments have not worked, and when the repair has to be precise enough to leave a finer line instead of a wider one.
The epidermis is stretchable but not strong. The dermis is where the wound has to heal, so that is where the sutures are placed.
The dissolvable sutures placed in the dermis take about six months to dissolve, giving the tissue time to heal and form a stable scar before the sutures are gone.
The depth and thickness of the advancement flap matter. Too deep and the tissue will not survive. Too shallow and the blood supply is compromised. The hair follicles are the guide, because they sit where the small blood vessels travel.
Asked plainly, answered plainly
No. The goal is to replace a thick, raised scar with a thinner, flatter line that may become nearly invisible over time. There will always be a scar, but it will be finer and softer.
Yes. The area is numbed completely with local anesthesia. The patient feels no pain, maybe just a little pulling.
Visible inflammation and bruising last about one week. The incision is strong enough to return to daily activity after about six weeks, once the deeper layers have healed.
Hypertrophic scars are raised and thickened. Lasers and fillers work for some acne scars, but a raised scar often needs surgical excision to be removed and closed properly.
Tension-free closure means the wound is closed with no pulling on the edges. The deep sutures placed in the dermis hold the tension so the surface edges can heal flat without thickening or widening.
The deep sutures are dissolvable and take about six months to dissolve completely. The surface sutures are removed or dissolve sooner, depending on the type used. The deep sutures give the tissue time to heal and form a stable scar before they are gone.
Yes. The same technique can be used for hypertrophic scars from trauma, surgery or other causes, as long as the scar is raised and thick enough to benefit from excision and advancement flap closure. Candidacy is determined at consultation.
A simple excision removes the scar and closes the wound edge to edge, which can create tension and a wider scar. An advancement flap raises surrounding skin and advances it over the wound so the closure is tension free, resulting in a finer line.
Ask Dr. Emer in person.
Every question above is answered properly in a consultation. Book online, or call the office.
A consultation with Dr. Emer covers your scar, your skin, and whether surgical revision fits your case.
West Hollywood and New York City