Acne scar from cystic acne - how to smooth out appearance? (photo)

Question

What type of treatment works best for my acne scar? I tried fraxel, micro needling. They worked a little bit. My iceberg acne scar is from cystic acne. It feels there is still something underneath the skin to make it not smooth. But it is not active acne. So I don't know what I can do with them.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nadir Qazi, DO · Answer

Acne scars can be frustrating to deal with, especially when it feels like you've tried everything. While treatments like Fraxel and micro-needling can help improve the appearance of acne scars, they may not always provide the desired results, especially for deep or stubborn scars.
In your case, it sounds like you have an icepick acne scar, which is a type of atrophic scar that occurs when the skin over a cystic acne lesion collapses and creates a depression. These types of scars can be particularly challenging to treat because they involve damage to the deeper layers of skin.
One treatment option that may be worth exploring is subcision. This is a minimally invasive procedure that involves using a needle to break up the scar tissue underneath the skin. By doing so, it can help release the depressed area and promote the growth of new collagen, which can improve the appearance of the scar.
Another treatment option that may be effective for acne scars is TCA cross. This is where we place a highly concentrated acid at the base of the scar to stimulate collagen production. 
If you have some more downtime, laser resurfacing may be worth considering. This involves using a laser to remove the top layer of skin and promote the growth of new collagen. However, it's important to work with a qualified dermatologist who can recommend the right type of laser and customize the treatment to your specific needs.
Ultimately, the best treatment for your acne scars will depend on the type and severity of your scars, as well as your individual skin type and concerns. It's important to work with a qualified dermatologist who can evaluate your skin and recommend a personalized treatment plan.

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