What can I do about all these holes in my nose? (photo)

A combination approach will give the most improvement. These types of scars need a combination of lasers, microneedling/prp, TCA cross, Cosmelan, punch excision and fillers. It will take a series of treatments. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

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

A real dermabrasion ( not a silly microdermabrasion) is the best option to smooth out nose scars and can be done under local.

I am sorry that you are having this particular difficulty. It is actually a relatively common problem, not just on the nose, but over the entire cheeks in some individuals. The at-home use of topical retinoids, like Retin A, and sailicylic acid, in my experience, are most useful for maintenance of benefits after other, in-office treatments have been performed. I have had great success through the years in treating dilated (enlarged, patulous) pores on the nose and elsewhere using a combination of simple and relatively inexpensive in-office treatments, including acne surgery, to physically extrude the blackheads and contents whose presence keeps the pores wide open and prominent. Following this, TCA CROSS has been found to work to shrink the pores, much as it is used to shrink and to narrow ice pick (pit) scars. And finally, medical microneedling may be used, if needed (and from the photo, it does not appear to be required here), to blend any residual pigment or texture irregularities that may be present. Once these procedures are performed, then an at-home tailored topical skin care regimen can be prescribed to help to maintain the benefits.

You do need to see someone to get a proper examination. Pores, ice pick scars, blackhead holes, etc... can all be treated. Treatment depends on the size of the pores, depth, downtime, and your skin type. TCA if used in this manner is called TCA CROSS, more info. below. See a specialist near you. All the best, DR Davin S. Lim