Need some advice on my acne scar. What procedures can improve my skin? (Photo)

Question

Hi, I'm East Asian and have some acne scars, especially on my left face, would like to know what procedures can improve my skin.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

No doubt in your research for treatments, you will be bombarded by recommendations for fraxel lasers, RF microneedling gizmos, ultrasound devices, punch excisions, and deep chemical peels. Just know in advance that the hard science to support the use of most of these expensive, "bells and whistles" gizmos lags woefully behind the hard science to promote them. Surgical excisions and punch excisions of scars runs the real risk for the subsequent development of stretch scars and tram track stitch marks. Chemical peels run the risk of scarring, and especially in skin of color, for post-treatment dyspigmentation problems that may be very difficult to treat. 
You would be wise to explore Field Subcision for globally improving both the cheek and temple scars followed by individual subcisions for rolling and boxcar scars that do not improve sufficiently from the Field Subcision. And, finally, TCA CROSS may be used for ice pick scars and dilated pores and is a technique that may be safely used in all skin types, and, in fact, was developed in South Korea for Asian skin with this issue. 
You would be wise to consult with an experienced, board certified dermatologist acne scar treatment specialist. Hope this helps and best of luck.

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