What would be the best treatment approach for my acne scars? (Photos)

Question

I've had these scars for 6 years. I believe they are majority atrophic and rolling scars. When I stretch my skin, most of them fade almost entirely and a few still remain slightly visible (as shown in my pictures) I've been heavily considering subcision + filler to treat them. Is this the best treatment approach? I'd love to see a 75%+ improvement.

Nelson Lee Novick, MD · Answer

The very fact that you get so much smoothing with stretching and that so few individual scars still remain strongly indicates that you are a good candidate for Field Subcision, which I have been performing for about twenty+ years. You would be wise to consult with a board certified cosmetic dermatologist with experience and expertise in performing Field Subcision, which is not to be confused with a a much more aggressive form of subcision using a device known as the Liberator. I have treated patients elsewhere for excessive fibrosis due to this much more aggressive procedure. Field Subcision, properly performed should take no more than ten or fifteen minutes to perform, typically yields immediate results and engenders little to no significant downtime. Make sure you consult a board certified cosmetic dermatologist with experience in performing subcision and do your "due diligence" before agreeing to just any procedure. Best of luck.

Jason Emer, MD · Answer

​Acne requires a combination approach to get long-term improvement. I recommend a combination of Cosmelan, salt facials, peels, lasers, microneedling with PRP, blue light, radiofrequency and isotretinoin. I suggest getting a formal evaluation with an expert. Best, Dr. Emer​

Raffy Karamanoukian, MD, FACS · Answer

The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Ajaya Kashyap, MD · Answer

Thank-you for your question! Deep acne scars can be very challenging. I have used subcision with autologous fat grafting followed by dermabrasion and/or laser resurfacing with a lot of success. I often add a little PRP with the fat cells. Filers also work along with subcision. Please find a board certified Plastic Surgeon near you who is experienced in these procedures, who can help you with all your concerns. All the best!

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