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Which treatment would be best for me to remove acne scars and decrease pore size? I am 42 with a long history of acne. (photo)

I am a stay-at-home mom, so downtime is not an issue. I went through 2 treatments of Accutane in the last 20 years. The last treatment was about 10 years ago.

Doctor Answers 11

Acne scars and pore size

This a great question with many answers. Its important to treat the active acne first. Once the active acne is minimized you’ll have many treatment options. First I would like to see you use a great medical skin care line at home. This will help your skin on a daily basis. A nice mild peel would be great for your skin on a monthly basis, this will keep your skin looking healthy and PH balanced. To help with the scarring and pore size I’d recommend approx. 2-3 micro needling treatments. I have seen fantastic results with these in office treatments. Continue with the mild peels during and after you have completed all your treatments.

Multimodal acne scar treatment

Thank you for your question. I find that multimodal approach to acne scar treatment is much more effective than any single treatment modality. The multimodal approach usually encompasses the following:
1) fractional laser resurfacing - CO2 is ideal for lighter skin types who can tolerate some downtime and usually requires one treatment. Radio frequency treatments are better for darker skin types or those who don't want as much downtime. They usually require several treatments.
2) Subcision techniques to break the tethering between the base of the scar and the underlying tissue. This is usually coupled with dermal fillers to help occupy the newly released space. Treatments are often repeated yearly, with improvements seen with each treatment as the untethered skin starts to remember it's less tethered state
3) Sculptra - is a specialized filler that builds collagen and when injected superficially, has also been found to help remodel the skin under the the acne scars
4) Ulthera - is a non-invasive approach to tightening the skin via collagen formation to help tighten the appearance of acne scars
5) Profound - is a minimally invasive radio frequency microneedling approach that stimulates Elastin, collagen and hyaluronic acid formation in the skin. It also shows promise in helping with acne scars, but does require more study.
6) maintenance therapy with chemical peels, microdermabrasion and skincare are also important measures.
7) keeping good control of any active acne is also important to help maintain a healthy looking skin and mitigate against future scar formation.

A consultation with a board certified plastic surgeon or dermatologist who has these multimodal approaches will be a great way to customize an approach for you.

Which treatment would be best for me to remove acne scars and decrease pore size?

It's very difficult to get rid of the scars but they can be improved. Fractora is a radio frequency based treatment I use that can help improve the appearance of acne scarring and help stop active acne as well. The only way to know for sure if this will work is to book a consultation with a board certified plastic surgeon that uses Fractora near you. Best of luck!

You Have Many Options to Remove Acne Scars

Thanks for your question and thanks for sending the photo along as well, it helps. You have many options, as most of the doctors who have answered the question, have noted. Skin care is a must, and again, a consult with a board certified dermatologist or plastic surgeon can help you determine the best skin care for you as well as the most appropriate laser treatment that we can use in your case.

Fractional devices are the most popular devices that we are using for acne scars. Non-ablative devices, such as the Cynosure Affirm, work very well with a series of treatments, usually 4-6, at four-week intervals, with minimal downtime. The ablative fractional lasers, such as the Lumenis UltraPulse, the Lumenis AcuPulse, the Syneron Core, or the Ellman Cortex, also work well on these scars, with 1-2 treatments usually needed, and with downtime that can be from 5-7 days, in most cases. The sublative devices, which are bipolar RF fractional devices, include the Syneron eMatrix and the Venus Viva. Our office performed the FDA studies for the eMatrix for acne scars so we know that most require 3 treatments, with minimal downtime, and some very nice clinical results. And a new class of devices, the RF associated microneedles, such as the EndyMed Intensif, also work well with minimal downtime; again, several treatments are needed.

So there are many options – make sure that you learn what is out there and know what to expect with each device that can be used.

Michael Gold, MD
Nashville Dermatologic Surgeon
4.0 out of 5 stars 11 reviews

Depends .... laser resurfacing is still the best.

First of all thanks for the photo.... you would be surprised the amount of people who ask questions without a good photo. It really tells a thousand words. I agree with Dr Hui, the first question is ' is you acne under control?' If not, consider anti- hormone medications such as Spironolactone or C. acetate. 

I personally would perform full laser resurfacing (none of this multiple fractional business). I would use an Erbium laser, treat your scars, till Im UNDER your scars (that is the end point), possibly finish off with CO2 5% 3 passes. This should improve things by 70-80%. Downtime? 9 days plus. 

Thanks for the photo, 
all the best, 

Dr Davin Lim
Laser and Cosmetic Dermatologist
BRISBANE, Australia. 

Davin Lim, MBBS, FACD
Brisbane Dermatologist
5.0 out of 5 stars 13 reviews

Acne treatment after Accutane

Thank you for your acne question.
  1. There is no simple answer - but a lot of options.
  2. Some skins respond dramatically to an aggressive skin care program, such as Obagi.
  3. Surgery to remove deep, sunken scars reduces shadowing.
  4. Fillers such as Radiesse can do the same.
  5. Stimulation of the skin with a no-down time laser or light peels often helps.
  6. Deeper laser and deeper peels are needed for others.
  7. Pore size is difficult to predict.
  8. See a Board Certified Plastic Surgeon or Dermatologist to review what bothers you, your goals and come up with a step-by-step plan. Best wishes.

There are many treatment options for acne scars.

Hello - first, is your acne under control? Please see a board-certified dermatologist and make sure you are on your way to acne-free skin. Great skin begins with a great skincare plan, including topical retinoids and daily sunblock with a gentle product containing ceramides such as CeraVe facial lotion SPF 30 or 50. 

Next, there are several treatment options available for your acne scars, depending on how severe your scars are. Small pitted scars can be treated with chemical peels to your entire face or localized trichloracetic (TCA) CROSS technique applied to each pit. This may require many repeat treatments, which will encourage your skin to create new collagen over the course of several weeks to months. 

You can also consider acne subcision, which is a "breaking up" of scars with a needle. Your doctor can also inject a dermal filler such as Belotero, which can help to fill in the scars after the subcision is done. This can also help to encourage new collagen formation.

A more intense approach would be laser treatments. Depending on your skin tone, fractional ablative (such as CO2 laser, best for white skin), and fractional non-ablative lasers can help to break up your scars and resurface your skin. These treatments also encourage new collagen formation, which will help fill in your scars. 

I hope this helps!

Andrea Hui, MD
San Francisco Dermatologic Surgeon
5.0 out of 5 stars 34 reviews

Laser treatment

Acne scars vary in type and thus treatment options may also be tailored the the specific patient. For cases like yours laser or microneedle techniques would be helpful. These methods basically induce controlled injury to to the skin causing development of new collagen and scar remodeling. They both have risks and I would suggest consulting with a board certified dermatologist or plastic surgeon who is familiar with lasers. 

Bishr Al Dabagh, MD
Santa Rosa Dermatologic Surgeon
5.0 out of 5 stars 2 reviews

Acne Scars

You may be a candidate for the Fraxel Dual Laser at the 1550 wavelength to treat your acne scarring.  The Erbium technology of the Fraxel Dual focuses energy in the deeper areas of the skin, stimulating new collagen production. The new collagen that is produced ultimately improves the fine lines, wrinkles, skin texture, and scars.  Fraxel delivers amazing results with almost no down time.  You should consult with a board certified dermatologist today.

Which treatment would be best for me to remove acne scars and decrease pore size?

Since your last treatment of Accutane was 10 years ago a laser treatment will be safe for you to have.  In general, patients should wait at least a year after finishing Accutane before having an aggressive laser treatment to improve acne scarring.

I would recommend a fully ablative CO2 laser procedure.  In comparison, a fractional CO2 laser would provide improvement but not to the level a "full" CO2 laser treatment would provide.  The downtime would be 7-9 days with some lingering redness to pinkness for 2-3 months.  The results would be significant but some of the acne scarring would persist.

I hope this helps.

Timothy R. Miller, MD
Orange County Facial Plastic Surgeon
5.0 out of 5 stars 36 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.