How to treat my acne scars? (photos)

I had a round of Fraxel Dual done in Jan/Feb 2015 with some success, but I didnt feel like I got my moneys worth. I started needling at 1.5mm 2 months ago, and I think it has helped a little. I am starting to get desperate, its difficult for me to leave the house or interact with people. Should I look in to another treatment, such as grafting, or fillers? Ive been considering bellafill but I dont know how effective it would be, and I worry about the risk of a permanent filler at my age (26).

Doctor Answers 4

Subcision Plus Fillers For Depressed Scars; TCA CROSS For Pits; Microneedling For Blending Surface Color and Texture

From the photos, you appear to have the full spectrum of acne scars: depressed scars (boxcar and rolling scars); pits (ice pick scars); and volume loss and sinking at least from the photo of the right cheek.

I am not surprised by the lack of success with a one-size-fits-all fraxel laser treatment series. If you have seen any of my other acne scar treatment answers, it should be clear that I am not much of a fan of them (nor of many of the other energy-based devices, like radiofrequency and ultrasound machines)--finding them relatively expensive and disappointingly far more device manufacturer backed marketing hype than hard science. 

Fortunately, a few tried and true and comparatively inexpensive approaches may lead to more gratifying results. Depressed scars should be elevated by subcision to break up the tethering bands of scar tissue that are pulling the scars downward followed by the injection of a filler to further elevate and support the skin and to additionally promote new, native collagen and elastin fiber synthesis. I share your hesitation about the use of permanent fillers, such as Bellafill, since permanent means if anything goes wrong, early on or even many years later--as sometimes happens--or you don't like the results, you are permanently stuck with them.

Pit scars can be treated with the TCA CROSS Technique, using either the traditional full strength TCA or full strength phenol. 

Medical microneedling treatments, perhaps using needle lengths up to 2.5mm can subsequently be used to blend better any residual surface tone and textural irregularities the treated scars with the surrounding normal skin.

Finally, sunken areas, such as appears to be the case at least with the right cheek can be volumized with a volumizing filler, which would serve two purposes: one to elevate the hollowing and secondly to stretch the overlying skin and by virtue of making it more taut make the overlying scars more shallow and less visible (i.e. less of the so-called "craters on the moon" shadowing that makes depressed scars more visible and outstanding).

For more information on any of the above, check out the archives of

You would do well to consult with a board certified aesthetic physician with experience and expertise in acne scar treatments. Best of luck to you.

New York Dermatologic Surgeon
4.8 out of 5 stars 22 reviews

Sculptra can minimize or diminish the appearance of scars.

 Micro-needling can be very effective. Combine a series of micro-needling with a little Sculptra and the results can be life changing. 
Sculptra stimulates your body's own collagen and is often used for anti-aging but because of the collagen production it delivers a more natural result than fillers. I often treat acne scars with a needling/Sculptra combination and have consistently good results.

Theresa M. Jarmuz, MD
Atlanta Facial Plastic Surgeon
4.6 out of 5 stars 11 reviews

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

Acne scarring requires a combination approach. Surgery, subcision, or TCA cross for deep or pitted "ice pick" scars. Fillers like Bellafill or Sculptra or Radiesse for broad "boxcar" or "rolling" scars. Eclipse Micropen for all types of scars and improvement in texture and tone. Lasers such as co2 laser resurfacing or Fraxel/Clear+Brilliant or radiofrequency such as Sublative or Viva to improve the scars and give long term collagen production. I suggest consulting with a board certified dermatologist for further assessment. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews


Fraxel is a laser skin rejuvenation treatment that resurfaces your outer skin, erasing imperfections. It also encourages the production of collagen, a protein found in connective tissue.The result is clearly visible lines, folds and wrinkles. Fraxel laser skin rejuvenation is a non-invasive technique that affects only about 20 percent of the facial skin exposed to it. The most common side effects of Fraxel laser treatment are swelling and skin redness, which should subside within a couple of days. Other temporary side effects may include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. The risk of infection or scarring is very limited. You should stay out of the sun 2-4 weeks.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 87 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.