The photo provided is quite adequate for determining that there appears to be significant facial volume loss in the lateral cheek region, and particularly in the medial and lateral mid-facial regions. Such underlying loss of volume can only contribute to deepening of any overlying, broader-based acne scars, such as rolling scars and boxcar scars. It would seem prudent to first reflate and reshape these regions, which would not only serve to rejuvenate the face in the 3D manner, but would likely give rise, by stretching them, to an almost immediate smoothing and improvement of the overlying acne scars. the results of this approach are immediate and typically engender a "Wow!" effect. In my Upper East Side Manhattan office, I would opt for Voluma XC and Radiesse Plus for these purposes. (In my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available, I would opt for Stylage XXL and Emervel Volume.) Once this is done, any remaining troubling scars above can be individually addressed. Subcision lifting with the addition of a biostimulatory filler, such Restylane Lyft (NY) and Hyaluronica 2(Israel) can work well for treating boxcar and rolling scars. TCA CROSS, employing eitther traditional full strength TCA or full strength phenol can then be used for any ice pick (pit) scars or excessevely enlarged pores. Finally, if necessary, medical microneedling may be used to achieve greater overall facial clarity and to achieve greater overal evenness of tone and texture of the skin. Despite the marketing, microneedling does not usually make a good stand-alone procedure for deeper scars and pits. I certainly agree with your caution regarding the use of relatively expensive fractional lasers, where unfortunately, the science simply has not kept pace with the promotional advertising and marketing materials from the manufacturers of the laser technologies. it is certainly wise to maintain a healthy level of skepticism about many of the "next best thing" toys to come to market these days. The same may be said of PRP, despite the current hype. Make sure that you seek consultation and treatment by a board certified aesthetic physician with expertise in acne scar treatments. Best of luck to you.
