Fillers are one option for treating acne scars but in my opinion they are no longer the gold standard to treat acne scars. The results are temporary as the filler product gets broken down over time. Lasers and other devices, particularly the fractionated lasers (which were invented by Harvard dermatologists), are currently the best way to improve these lesions in my opinion. I would recommend seeing a physician with advanced training in laser surgery. Understanding how these lasers work, can give you safer and better results.
There are many other treatments now available for acne scars. One of my preferred treatments is Sculptra, a collagen stimulator, which when injected under the skin causes your body to form collagen in the areas of the scars and gives a permanent improvement. Sometimes several treatments are needed and sometimes these treatments can be combined with Fractionated laser or Ultherapy for further improvement. One exciting new technology for treatment is Thermi RF tight and smooth which are approved for skin and soft tissue tightening but also work by stimulating the body's own collagen and might be helpful depending on the area of acne scarring.
If you check out the archived of Realself, you will find that I have written extensively on the subject of the combined treatment of acne scars using first subcision followed immediately by the injection of a biostimulatory filler.
The subscision breaks up the downwardly pulling tethering bands of scar tissue--allowing the base of the scar to float upward. Even more importantly, it facilitates new native collagen synthesis to occur over the next several weeks to replace the treatment fractured scar collagen. The subsequent introduction of a biostimulatory filler, such as Radiesse combined with Perlane L in my Upper East Side Manhattan office (or Radiesse plus Restylane SQ in my Israel satellite office where the latter is regulatory agency approved) promotes additional neocollagenesis within the next several weeks and at the same time provides an immediate lift to the base of the scar yielding a gratifying on-the-spot improvement.
One would need to know which filler substance was used. There are several categories of filler substances that can be used for acne scarring. Some swell immediately with injection and therefore, there is caution with the amount of substance that is injected due to the potential of overfilling. Overall, those type of fillers are temporary. There are collagen stimulating fillers that work in different manner. For this reason, they are my preferred filler substances when treating acne scars.
When filler is put in, there is some subcision that occurs from the needle or canula. Sometimes this is enough to help free up the scar tissue so that the filler can keep it elevated. If your scarring is deep or you had some large scars, a more aggressive subcision is often indicated. There are many lasers, for ex. the 1540nm laser from Palomar) which can also help to free up the scars and help to produce some new collagen under the skin. Fat is also a good choice since it is long lasting and has stem cells which can help to improve the skin quality.
Thank you for that excellent question. Unfortunately scarring from acne is very common.
And treatment is difficult.
I always tell my patients that we can likely improve this fine but it is difficult to eliminate it.
A combination of fillers, chemical peels, and various lasers can be used to improve the appearance.
I hope that helps.
Dr. Daniel Radin. Dermatologist, Windsor, Ontario,Canada
Yes, it is possible to subcise the scars and then fill. In my office, I prefer to subcise and wait about 90 days before treating the remaining area with filler. The subcision itself will result in improvement to the scar, sometimes dramatically. Acne scars, in my opinion, always do better with multi-modality treatment, using a combination of subcision, filler, lasers or chemical peels.
.... your problem is not uncommon. Sometimes we need to take fillers in steps, much like building blocks. For example, if you lack volume, a thick filler like Juvederm Voluma can help, this lifts your acne scars from underneath. If you have superficial scars, then using a more fluid filler such as Juvederm Volbella can be excellent. Layering and not going overboard is the key.
For scars, its much harder technique than just volume. Don t be disheartened if you need several treatments to achieve improvement.
Dr Davin Lim
Cosmetic and Laser Dermatologist