Boxcar scars and dry skin - what treatment would be best? (photos)

Question

Hormonal acne started in 2021, due to abruptly stopping birth control. Having now gotten back on birth control this past year in 2022, I no longer have breakouts. My skin used to be amazingly perfect as I had acutane as a teenager & through the years put much money into protecting my skin from any damage and no I've never "picked" my face. I've had 1 fraxel laser treatment for entire face & 2 TCA peels targeting my ice picks scars. Now I'd really like to get the box car car gone. I hate my skin.

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

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. 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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Amelia Damse, DO · Answer

When it comes to acne scarring, a combination of treatments, and usually multiple treatments, will yield the best results. We like to combine TCA CROSS method with fractional resurfacing. Sometimes adding subscision with/without small amounts of filler helps to boost those results and get you to your goal faster.

Camille Cash, MD · Answer

I encourage you to meet with a board certified plastic surgeon for an evaluation.  Photos are helpful, but do not take the place of an in person assessment.  Two options for you to consider are laser resurfacing and Morpheus8.  This treatment is a combination of microneedling and RF technology that is helpful to improve overall skin tone and texture.  Optimal results are seen after three treatments.

Boxcar scars and dry skin - what treatment would be best? (photos)

Answers (4)

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