Looking for the best course of action for SEVERE acne scarring and blackheads. (photos)

With some active acne on AF. AM. skin. I have been stalking and lurking on this site for years - finally decided to be proactive. Like so many others I have spent thousands on over the counter/DIY/flavor of the month treatments. I had cystic acne for years and it's (mostly) gone now but the scarring is horrible and I have no way to make it better. My issue is layered because I have black heads, the three worst thpe of scars, Af Am skin (nonkeloiding) and I'm 40+. I am ready to invest in treatment though and could use some guidance.

Doctor Answers 5

Multiple treatment methods.

Firstly, your skin needs to be treated. There a two DISTINCT problems here. Firstly , blackheads and acne, secondly scarring. The first problem can be dealt with medically - peels, topical, vitamin A, Accutane, etc... general dermatologist can assist. Second problem, scars. Mixed scars, ice pick , rolling, atrophic. This is on the back ground of dark skin. You will need punch excision, TCA CROSS (with skin colour changes), Insulated microneedling RF, subscision and fillers. If you are motivated, you will receive a good result. Look at a time frame of one year, with 6-8 treatment sessions. Wishing you the best, Dr Davin Lim, Brisbane. Australia. 

Brisbane Dermatologist
4.7 out of 5 stars 56 reviews

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

A combination approach is needed to get the best outcome. I suggest you see an expert who can get you on a short and long term plan including lasers, fillers, subcision, and skin care. Please consult with a board certified dermatologist. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 159 reviews

Acne scars, AA skin

In addition to the previous reply, I would add TCA CROSS. TCA CROSS uses high strength TCA (acid) directly placed into the deep ice pick scars. In published studies of African American and Indian patients, and in my personal clinical experience, it is safe for all skin tones. Be well.

Estee Williams, MD
New York Dermatologist
5.0 out of 5 stars 7 reviews

Top expert for acne scars in Los Angeles

I would begin with a combination protocol of Ematrix RF, Yag lasers, topical Melapads, hormonal evaluation, and light chemical peels for your acne. Best, Dr. KaramanoukianLos Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 93 reviews

Comprehensive Approach to Oily Skin and Acne Scarring

My apologies for a long answer but your course of action requires several types of treatments.First, FIRST- you MUST repair your skin with an aggressive topical program medical grade. If you don't you will be at high risk of complications from procedures (hyperpigmentation, infection, scarring, hypopigmentation) AND the procedures will not work as well and your healing phase will be more difficult. Do NOT go straight to a procedure. I suggest this for topicals (ZO Skin Health below, combined with Retin-A otherwise known as tretinoin) which you will start 3 times a week at night and gradually increase over the course of 6 weeks until you are tolerating it every night. The strength of the tretinoin should be 0.05 or 0.1%) You will need to find someone near you who carries this line and can prescribe the tretinoin. It would also be great if you could have a few Hydrafacials or even regular microdermabrasions, with blackhead extractions, at the start- it won't help the scarring but it will clear away some of the dead skin cell layer and cellular debris- this will help your topicals penetrate better.
AFTER you have been on a skin conditioning regimen like this one for 12 to 18 weeks you can and should then switch to a non-hydroquinone regimen (ZO skin health has that as well)- but continuing on products containing both micronized encapsulated retinol as well as lighteners and the tretionoin.At that point you can consider trying procedures. Your skin will be resistant to post-inflammatory hyperpigmentation and other complications thanks to the skin conditioning done prior. You next best step is some form of fractional resurfacing- this can be done with CO2 (Fraxel for example), with Erbium (ex: Sciton- ProFractional), or with radiofrequency (ex: EndyMed 3 DEEP, or Sciton's eMatrix). On a brief search I found a number of spas in Baton Rouge that had the ProFractional device. Most of these places have financing options so you can pay over time.Be sure to go with a facility that has a lot of experience with their device.Best,Lisa Vuich, MD

ZO® Multi-Therapy Hydroquinone System - RX

An all-encompassing system formulated to help
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Melamin™ Skin Bleaching & Correcting Crème – Net Wt. 32 g / 1.12 Oz.
Glycogent™ Exfoliationg Accelerator, 10% Concentration – 30 mL / 1 Fl. Oz.
Melamix™ Skin Lightener & Blending Crème – Net Wt. 32 g / 1.12 Oz.
Ossential® Daily Power Defense – 30 mL / 1 Fl. Oz.
Oclipse-C™ Broad-Spectrum Sunscreen SPF 50 – Net Wt. 60 g / 2 Oz. 


  • Treats moderate to severe hyperpigmentation, especially melasma
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  • Great to use as pre/post procedure skin conditioning to help maintain results longer
  • Helps improve overall appearance and quality of skin

Lisa Vuich, MD
Nashua Physician
4.7 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.