Why do most doctors push patients away from Dermabrasion for deep acne scars? What's the best method for deep acne scar? (Photo)

I have been to 5 Facial plastic surgeons in Atlanta for consultations and have had Fraxel laser (9 trmt), micro needling (6 trmt) for acne scars and there was no difference or improvement. Most Doctors mention a different laser that is supposedly the best and avoid talking about Dermabrasion when I ask if it would work. . I don't want to try 5 more diff. lasers and/or 15 diff. treatments (fillers, needles, etc) that are not going to work and it are a waste of money. HELP :(

Doctor Answers 6

Best treatment for deep acne scars

There are several different types of acne scars, for which there are different treatments. Deep scars often respond best to several modalities and not just one. In many cases, surgical excision followed by dermabrasion or laser resurfacing is best. Unfortunately, with your skin type, use of more aggressive lasers can be difficult as you are at risk of pigment changes. "Safer" procedures, such as Fraxel and microneedling are options, but afford minimal benefit, especially for deep acne scars.

Dermabrasion is a great option, especially after surgical excision. This takes more skill to perform than any other procedure. Short term options include fillers, which last approximately 6 months and have almost no downtime.

The bottom line....
Find someone who specializes in acne scar treatments and, in particular, in patients with your complexion. Most Plastic Surgeons specialize in Breast Augmentation, not acne scars. Many Dermatologists specialize in fillers and toxins and not acne scars. 

Good luck!

Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Dermabrasion versus Lasers

For most scars fractional lasers or eMatrix is preferred since you don't have to suffer the down time.  Unfortunately, when you have deep scars you may require dermabrasion.  Dermabrasion has become a lost art and I only know one plastic surgeon in NYC who is still skilled to do this.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Dermabrasion for deep acne scars

  I am sorry that you have had so many treatments without improvement in you condition.  The truth is that these scars are very deep and that mild and medium treatments will not be effective and this certainly includes the fractional lasers and microdermabrasion you have had before.  I think that you need deep facial resurfacting combined with fillers and excision/subcision of the worst scars.  Deep resurfacing can be accomplished with dermabrasion, chemical peels or lasers.  There is no single best treatment.  The best thing that you can do is to select a physician who has experience with these modalities and who will work with you to achieve the results that you are seeking.

Lawrence Kass, MD
Saint Petersburg Oculoplastic Surgeon
4.9 out of 5 stars 134 reviews

Treatment for deep acne scars

In my practice, I do many CROSS treatments for ice pick scars.  This requires application of 100% TCA into each scar.  I usually recommend 5-6 treatment sessions.  There is about a week of small scabs or crusts at each treated site but the surrounding skin is left untreated so recovery is easy.  Most patients are pleased with the improvement.  

Richard Ort, MD
Lone Tree Dermatologic Surgeon
5.0 out of 5 stars 27 reviews

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

Deep scars need a long term plan.  Often that means surgery + lasers + fillers.  You need a cosmetic dermatologist who specializes in acne scarring/pigmentation and does a combination of treatments including: 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 Venus Viva to improve the scars and give long term collagen production. There are many options but you want someone who can customize a regimen for your short and long term goals based on your individual situation. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 196 reviews

Best treatment for deep acne scars

Hello annarosaperez,

For deep acne scars, resurfacing procedures such as dermabrasion, lasers, micro needling, etc., will not work.  Dermabrasion works by bringing the surrounding skin to the level of the acne pit.  With a deep scar it is deeper than dermabrasion can be safely taken.  With micro needling and lasers they work by stimulating new collagen.  This also is more than what can be accomplished with a deep accent scar.  The best treatment for a deep, ice-pick acne scar is to actually excise it.  This changes the deep acne scar into a linear surgical scar.  This new scar can then be improved and blended with the surrounding skin using one of the resurfacing procedures mentioned above.  

I would recommend you consult with a facial plastic surgeon, plastic surgeon, or dermatologist who is skilled in the above to verify you are a good candidate for treatment.  

I hope this helps and good luck.  

William Marshall Guy, MD
The Woodlands Facial Plastic Surgeon
5.0 out of 5 stars 28 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.