Anna Chacon, MD, FAAD

Chickenpox scars, especially when longstanding, can be challenging to treat because they are often deeper, pitted scars. A strong chemical peel, such as a TCA peel, can help resurface the skin and improve overall texture, but it typically offers only modest improvement for deeper scars. For more noticeable results, fractional lasers (such as CO₂ or erbium), microneedling, or a combination of treatments are generally more effective in stimulating collagen remodeling and improving the depth of these scars. In some cases, subcision or fillers may also be considered, depending on the scar type and depth. In short, while a TCA peel can help with texture and pigmentation, advanced modalities like fractional lasers and microneedling are usually more effective for chickenpox scars, particularly on the nose where the skin is thicker and scars are often more resistan

Sculptra (poly-L-lactic acid) works by stimulating your body’s own collagen production gradually over time. While it is well documented to improve skin thickness, volume loss, and overall texture, the improvement in tensile strength is more of an indirect effect. By enhancing collagen formation and supporting the extracellular matrix, the skin often becomes firmer and more resilient. Elastin regeneration, however, is not as robust as collagen stimulation—Sculptra’s main mechanism is collagen neogenesis rather than elastin production. So while you may notice improved firmness and support in the skin, true elastin regeneration remains limited compared to collagen. In summary, Sculptra helps restore structural integrity and firmness, which can feel like improved tensile strength, but the primary benefit comes from collagen induction rather than direct elastin synthesis.

Thank you for sharing your concerns and photos. Acne scars are often complex because, as you mentioned, multiple scar types may coexist and require different treatment modalities. The key is often not just the procedure itself, but the right sequence, intensity, and number of sessions. For ice pick scars, TCA CROSS remains one of the most effective methods, as it targets the depth and helps stimulate new collagen formation. For rolling scars, subcision is beneficial, but results may be more pronounced when paired with platelet-rich plasma (PRP) or biostimulatory fillers such as poly-L-lactic acid (Sculptra) to prevent tethering and support healing. For boxcar scars, fractional ablative lasers (like CO₂ or Er:YAG) or microneedling with radiofrequency can help refine the edges and texture over multiple sessions. For papular scars, light electrocautery can be useful, though occasionally laser resurfacing or excision may be considered if they are prominent. It is important to note that a combination approach—TCA CROSS + subcision with filler support + resurfacing (fractional laser or microneedling RF) in a staged manner—tends to yield the most improvement over time. Because scar remodeling is gradual, several sessions are usually required, and improvements are typically seen progressively rather than after just one or two treatments. Patience and persistence are essential, but with the right tailored plan, meaningful results can be achieved.

Hello, thank you for sharing your concerns. At age 37, it’s very common to notice early signs of facial aging such as under-eye bags, fine lines, and loss of volume in certain areas. Based on your description, there are several approaches that may help restore a refreshed, more youthful look: Lower eyelid surgery (blepharoplasty): This can reduce puffiness and under-eye bags, making the eyes appear brighter and less tired. Dermal fillers: These can replace lost volume in the midface and under-eye region, softening hollows and creating a smoother transition between the lower eyelid and cheek. Skin resurfacing treatments (laser or chemical peels): These improve skin tone and texture, minimizing fine lines and sun damage. Neuromodulators (Botox): Helpful for softening dynamic wrinkles and refreshing the upper face. A combination of these treatments often provides the most natural and rejuvenated outcome. Lifestyle factors such as sun protection, hydration, and a consistent skincare routine with retinoids and antioxidants also play a key role in maintaining results.

Scarring after permanent makeup removal, particularly with methods such as Rejuvi, can sometimes result in textural irregularities, discoloration, and firmness along the lip border. The goal of treatment is to improve smoothness, reduce scar visibility, and restore a more natural contour. Several approaches may be considered: Laser resurfacing (fractional CO₂ or erbium laser): Helps smooth raised or indented scars, stimulate collagen remodeling, and improve pigmentation. Microneedling or RF microneedling: Can soften scar tissue and gradually improve texture over multiple sessions. Steroid or 5-FU injections: May help flatten raised or firm scar tissue if there is hypertrophy. Chemical peels: Mild to moderate peels can help improve pigmentation irregularities but may need to be combined with other treatments for texture changes. Topical treatments: Medical-grade silicone gels, retinoids, or lightening agents can assist with discoloration and scar softening. Camouflage tattooing (paramedical micropigmentation): Once the scar is stable, some patients benefit from blending the color difference with specialized tattooing techniques. A combination approach is often the most effective, depending on whether the main issue is raised tissue, indentation, or pigment change. Improvement is gradual and multiple sessions are usually required, but significant softening and blending of the scar can typically be achieved.