I love the fractionated CO2 laser for acne scars
My first patient using the Pixel Omifit handpiece on my old CO2 laser for her "hill and valley" acne scars looked so much better she decided to go to Weight Watchers to complete her "new self". I find a series of treatments are necessary for the ice pick type of scars. They actually disappear but with several treatments. If needed for "tied down scars," subcision could easily be added to the laser treatment.
Acne scar treatment with fillers
You mention you had acne breakouts and peeling from injecting the scars. I question if you didn't have an exacerbation of a cyst like structure underneath the scar. Sometimes, acne cysts scar the skin, but the cyst can have a lining or capsule that remains dormant and the filler might have disrupted it. This can happen with all resurfacing treatments too, but it might be worth a try. Multiple Fraxel restore treatments have helped many patients with acne scarring. Another modality involves the very careful application of a very strong chemical peel agent to the base of the scar's surface, done multiple times, weeks apart. Over time these "wounding" peels, help create collagen underneath the scar and the scar lifts up. Another treatment is called punch grafts. If the scars are narrow and depressed, they can be cut out and replaced with a narrow skin graft from behind the ear. These are usually done on "ice-pick" scars, not shallow "crater-like" sloping scars. There are some doctors that use Silicone injections for underneath acne scars as an off-label treatment, but you might have the same peeling result as you did with the Restylane. This treatment is controversial as there is a risk of migration of the Silicone and the delayed development of granulomas, or nodules, even twenty years, or more after treatment which would need surgical excision possibly, and this could leave you with more of a scar.
See an experienced acne scar expert in consultation, whether a board certified dermatologist or plastic surgeon.
The best alternatives would Fraxel laser resurfacing
For acne scarring the better treatment is generally accomplished by Fraxel laser resurfacing either the Restore or CO2 Repair.
However fillers also help.
You may want to try Radiesse since you have had side effects with Restylane.
Acne scarring treatment options
There are many types of acne scars and the choice of treatment depends on the type of scarring. I would recommend having a dermatologist evaluate your scar, and then choose the most cost effective treatment.
Acne scar surgery and resurfacing is better for acne scarring compared to just fillers
The use acne surgery in combination with CO2 resurfacing provides long lasting and significant improvement. The use of subcision (the breaking of scar adhesions that cause the rolling scarring that is seen with acne scarring) and removal of ice pick scars are sometimes necessary to fix the "pot holes" prior to resurfacing the skin which evens out and smoothes the skin.
I hope you find this helpful.
Depressed acne scarring can be treated with injectable fillers like restylane or juvederm. Artefill is another product that has currently been used with some success in elevating acne scarring. Other options include laser resurfacing to make the scars blend in better with the neighboring tissue. I hope this information helps.
You are probably better served with a different modality of treatment. As you know acne scarring presents in a variety of forms. You may benefit from Erbium laser resurfacing which would remove the shoulders making the depressions less obvious (check out doctors who own and know how to use the Sciton Profile or Joule laser). If further care is needed, I would then do Subcision with another filler. That should greatly enhance your appearance.
Dr. P. Aldea