Struggling with scars and skin texture from large pores (photo)

Question

I am 35 years old and I struggle with acne scars on the sides of my cheeks and i have large pores that create a horrible orange peel effect on my cheeks. I have tried several things for this such as Co2 laser, microneedling, sculptra, and glycolic acids and tretinoin. No matter what i try i cannot seem to get any results. Does my collagen just not react like a normal person? I just want to have that smooth beautiful skin that i can feel confident in. What can I do?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

I'm sorry to hear about your struggles with acne scars and skin texture. Achieving smoother skin can be challenging, especially if previous treatments haven't provided the desired results. Here are some considerations and potential next steps you might discuss with a dermatologist:

Evaluation
Comprehensive Assessment: It's crucial to have a thorough evaluation by a dermatologist to assess your skin type, the severity of scarring, and pore size. This will help tailor a more effective treatment plan.
Treatment Options
Advanced Laser Treatments:

Fractional Laser Resurfacing: This can be more targeted and might offer better results than CO2 lasers for some skin types.
Erbium Laser: This laser might be less aggressive than CO2 but can still effectively improve texture and scarring.
Chemical Peels:

TCA Cross: This technique uses trichloroacetic acid to spot-treat deeper scars and can be effective in combination with other treatments.
Dermal Fillers:

If previous fillers like Sculptra didn't work as expected, other fillers such as hyaluronic acid-based options might provide different results.
Radiofrequency Microneedling:

Combining radiofrequency with microneedling can stimulate collagen production more effectively and improve skin texture.
Platelet-Rich Plasma (PRP) Therapy:

PRP, combined with microneedling, can enhance healing and collagen production.
Customized Skincare Regimen:

Continuous use of retinoids and professional-grade skincare products can gradually improve skin texture over time.
Lifestyle and Maintenance
Sun Protection:

Consistent use of sunscreen is vital to prevent further damage and hyperpigmentation.
Diet and Hydration:

A balanced diet rich in antioxidants and adequate hydration can support skin health.
Consultation with Specialists
Seek a Second Opinion:
If previous treatments have not been successful, consider consulting another dermatologist or a specialist in cosmetic dermatology for a fresh perspective.
Remember, each individual's skin responds differently to treatments, and sometimes it takes a combination of therapies to achieve the desired results. A dermatologist can help guide you through these options to find the most suitable plan for your skin.

Camille Cash, MD · Answer

From your descriptions the best place to begin is a visit with a board certified plastic surgeon or experienced aesthetician for an evaluation.  Morpheus8 may be a good option for you.  This treatment combines RF technology with microneedling to improve overall skin tone and texture.  Microneedling with Plasma may be another option.  We always recommend using medical grade skin care products and wearing sunscreen every day.

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