Advice on what treatments will be most effective for my acne scarring? (Photo)

Question

I suffered with severe acne during my teens which has left me with scarring on my cheeks, temples and forehead. I have tried countless sessions of microneedling, tca cross and have had two sessions of subcision (not the Taylor liberator). I have never tried laser as I am afraid of the hyperpigmentation I may get as a result of me having a brown complexion. Please could you advise me on what treatments would be best to minimise my scarring in particular on my temples.

Nelson Lee Novick, MD · Answer

Closeup photos would have been very helpful. However, from what can be seen, there is considerable acne scar related atrophy in both the cheeks and temples for which Field Subcision would be appropriate treatment options. It is difficult from the photos provided to discern how much ice pick scarring is present. TCA is best reserved for ice pick scars and dilated pores; it would not be expected to be effective for boxcar and rolling scars--which seem to predominate here--which may account for your lack of success with this approach. Microneedling is best reserved for a final "polishing" step--rather than as a primary therapy--after more appropriate acne scar treatments have been performed. This could account for your lack of success with this approach. As far as individual subcisions, ordinarily between two to six treatment sessions on average three to four are necessary to achieve optimal improvement. You have only had two sessions and your physician should have explained this to you to prevent unnecessary and premature disappointment. I agree with your hesitancy for expensive laser treatments. There is definitely concern regarding dyspigmentation, particularly in individuals with skin of color. What's more, the hard science to support the use of these expensive "bells and whistles" gizmos lags woefully behind the heavy marketing hype and social media buzz. You might consider discussing continuing with the individual subcisions for another couple of sessions and to discuss Field Subcisions with him/her. Best of luck.

Advice on what treatments will be most effective for my acne scarring? (Photo)

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Advice on what treatments will be most effective for my acne scarring? (Photo)

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