What procedures would you recommend for my acne scars based on my skin colour? Subcision or TCA cross? (photos)

Question

I have struggled with acne for years which I always dealt with but recently in the past couple years my face started scarring after my acne went away, and I would never pick or touch my face. Had to take Accutane, thankfully no more active acne but sadly left with terrible acne scars on my cheeks, want to fix the more pronounced scars. I've been looking at subcision along with Prp+fillers but would like other opinions please. Do you think TCA cross would be ok for my skin tone?

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I am so gratified to see that you have apparently not been taken in by the all the hype for the expensive, "bells and whistles," energy-based devices, like fraxels and RF, etc. that have little hard science, but plenty of marketing hype to speak for them. The same, incidentally, can be said of PRP. TCA CROSS, which I have been performing for twenty-two years is an excellent and relatively inexpensive technique for ice pick scars (which seem to predominate in the photos provided) that has a proven safety and efficacy track record in all skin types. It is not the treatment of choice for boxcar or rolling scars. Subcison, which I have been performing since 1994, is another relatively inexpensive, safe and effective treatment and is more appropriate for wider-based scars.  Make sure that you consult with an experienced, board certified cosmetic dermatologist. So, take heart. and best of luck.

Martie Gidon, MD, FRCPC, FAAD · Answer

You require a combination of treatments including TCA CROSS, subcision, fractional laser, microneedling, PRP and possibly filler. You will need to pretreat your skin with fading products, Retin A and sunscreen. Please consult a cosmetic dermatologist who can advise you.

What procedures would you recommend for my acne scars based on my skin colour? Subcision or TCA cross? (photos)

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What procedures would you recommend for my acne scars based on my skin colour? Subcision or TCA cross? (photos)

Answers (3)

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Everything you need to know about Subcision

Our mission is to create a world where every investment in modern beauty is Worth It.