scarred knees

Dear Dr.  I have always gotten complimants on my legs...I have very pale skin, somewhat long legs with big muscular calves BUT my knees are aweful.  I am 41 yrs old and I guess when I was a child I played really rough and scarred my knees so now they are slightly scarred, rough and dark... So when you see the back of my legs they look beautiful but then turn around and my knees stand out!  What do you recommend??? Please help!

[Howard Rosenberg, MD]

I am pessimistic that there can be any dramatic improvement in the appearance of your knees with either surgery, laser or topical therapy.  The skin of the lower extremities is notoriously difficult to improve because of multiple factors that facilitate healing including reduced blood supply compared with other areas of the body and lack of accessory (sweat type) glands.