I live in LA, so there’s a lot of demand for those sorts of procedures here. You’d want to either look for a cosmetic dermatologist or a plastic surgeon. Either will be able to advise you. I’m a trans woman with some pitting along her right upper lip from electrolysis overtreatment – the opposite of your situation, but the end result looks somewhat similar. I’ve been having microneedling sessions done with a fair amount of improvement.
*** Please note that I am not a doctor. ***
Microneedling is relatively inexpensive, and as the process doesn’t deliver energy into the tissue, it is virtually risk-free. You’re going to want to see a doctor to have this done. Only MDs (and I think medical aestheticians) can go deep enough (about 2 mm) to affect scar tissue. A typical beauty spa can only go about 0.25 mm, if I recall – enough to tone the skin nicely, but not enough to address deep scars. Expect three to six sessions. I’m paying $350 per session, but these are LA prices. Some places isolate PRP by centrifuging your blood, and smear it across the microneedling wounds to promote healing. My dermatologist cautions that this may result in additional collagen growth if you’re still getting electrolysis. Be warned. There are also new devices that combine microneedling with RF energy (Infini, Intensif, Fractora), and sometimes these are marketed as “lasers”. I’ve heard of amazing results from these, but I’ve also heard horror stories, again from my dermatologist. Expect mild redness and some peeling, similar to a sunburn, that lasts about a week. They’ll likely provide you with some topical anesthetic, and the pain is about as severe as scrubbing your face with sandpaper – no problem if you’ve done electrolysis!
Fractional laser therapy is actually several different things. The term “Fraxel” (often misheard as “fractal” – sorry Seana) is a brand name, and can refer to one of several types of lasers. Another less common brand is Sciton. Like electrolysis, the specific type of laser is far less important that the skill of the operator. Typically, a doctor will carry only one brand because they are expensive to purchase. Your provider will likely talk about one of two types: ablative and non-ablative.
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Ablative can be thought of as the laser drilling tiny channels into your skin, similar to microneedling but with laser energy. There will also be some heat involved, which will kickstart collagen production and hopefully fill in the dents. The downtime involves about a week of looking like you were burned in a grease fire, although I’m told it’s not painful. You’ll likely need to smear an ointment like Aquaphor on your skin to keep it hydrated. There will also be several months of redness that gradually diminishes. Common ablative lasers are the Fraxel re:pair and the Sciton Profractional. If cost is an issue, you don’t have to do your full face. You can simply spot-treat an area, although the redness will be more obvious if isolated to a particular spot.
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Non-ablative lasers don’t “drill” channels, but instead heat the underlying dermis without penetrating the epidermis. The results are more subtle, and non-ablative treatments are typically done in a batch of three to six sessions, spaced about six weeks apart. I’ve been told by different doctors that non-ablative lasers cannot get the results that ablative lasers can, and by other doctors that the two ultimately result in the same end-result. I don’t know. I do know that the downtime for non-ablative is quick, a day or so of mild redness. (I’ve had it done on my cheeks and temples.) A common non-ablative laser is the Fraxel re:pair.
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Other specialty lasers are the Sciton HALO, which combines a non-ablative and ablative laser, and the Fraxel Dual, which combines a non-ablative laser with another type that addresses pigment problems.
I suspect that your doctor might recommend subcision, where they release the scar tissue that’s tethering the skin down to the deeper layers by severing it with a hypodermic needle. I’ve had this done for some indented acne scars on my cheeks. Not painful at all, reasonably effective. Some slight bruising that heals nicely. Your doctor may follow this up with a small bit of filler. Some fillers can assist in building collagen, but most just plump the area up. These are temporary (a couple of years at best) but are visually very effective, and often the only solution that ends up working in the end.
Good luck! Know that you aren’t alone!
