What's the best treatment for my acne scars? (Photo)
Doctor Answers 9
A combination of laser resurfacing and subcision using tumescent anesthesia works best for your type of scars.
A Combination Of Techniques, Rather Than "A One Size Fits All" Approach Is Best For Treating Acne Scars
Different treatments for acne scars are applicable to depth, and types of scars - there are substitutes for fillers available
Thank you for the question. You submitted 2 photos, and state 8 years prior you had severe cystic acne. You took Accutane for 6 months and you state you are now left with multiple pitted scars, as well as some hard scar tissue below the skin. You are looking for some guidance on improving your appearance, but you are not interested in fillers.
I can certainly give you some guidance on how I approach patients like yourself and acne scar situations in general in my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I have a full series of options available to my patients to treat acne scars, which are ultimately customized to each individual’s needs.
You made one specific statement about not wanting fillers. If we take fillers off the table, you are restricting some opportunities that use traditional fillers. Often, people come to us with the same request for a variety of reasons: they think fillers are expensive, or they don’t have time for filler treatment.
To begin with understanding the different types of acne scars helps guide any doctor in how to optimize the results of treatment. Let’s start with where fillers actually fit, and what we use as a filler substitute. The types of acne scar called rolling scars and atrophic scars are best managed with fillers. These are the scars that appear to improve when you pull the skin and stretch, which then soften up, meaning there is room to work with underneath. When someone has that type of situation, and they understand that although they don’t want fillers, but they want volume, the options include fat grafting. Fat grafting means harvesting fat from one place, and placing them under the skin of the face and within the skin. We also use platelet-rich plasma (PRP), or platelet-rich fibrin matrix (PRFM). Very often, because of logistics, people choose platelet-rich plasma (PRP) or platelet-rich fibrin matrix (PRFM) as the first line treatment because fat grafting is a surgical procedure that requires a certain amount of operating room time.
What we do with platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) is concentrate the growth factors and the healing factors that naturally stimulates collagen procedure as part of the healing process. Just to give you a brief explanation, PRP is derived from your own blood, so for people who want something all natural, it doesn’t get more natural than coming from yourself, and from your own blood. This benefits scar tissue, and improving vascularity, while the blood vessels also benefit. We’ve used platelet-rich plasma (PRP) for acne scars, as well as to soften scar tissue. Platelet-rich fibrin matrix (PRFM) is a little different, but it’s still PRP, but is activated so it’s made into a gel, which acts like a time release capsule so it allows growth factors and other things to be released in a specific way, so you get both the correction short-term from the gel, and you get some correction from the replacement of that gel with your body’s own tissue. It is not the same as getting hyaluronic acid fillers, but is certainly more palatable for people who don’t want fillers.
We can also help release any scar tissue with a procedure called subcision where scar tissue underneath the skin is released, allowing the skin to elevate to provide room for platelet-rich plasma (PRP), platelet-rich fibrin matrix (PRFM).
There is also a type of ablative laser strategy often beneficial particularly for boxcar scars. These are scars with very sharp defining edges. Generally, when using a laser, we try to soften the edges of these scars, then blend the skin so the skin heals smoothly for improvement.
There is also acne surgery where scars are excised, sutured, then closed, then the healed area can be laser resurfaced. This strategy takes several months to actually execute, so you don’t necessarily do everything at once.
Especially with the field of regenerative medicine, you treat, you observe and then you strategize, so it’s very important you identify a doctor you are comfortable with, and you are willing to work with, and who is willing to work with you with these stipulations of not wanting injectable fillers. Once you find a doctor, you will get an understanding of the level of expected improvement. For yourself and the doctor, define what is success. For me, I try to help patients define success simply by one word - improvement. If there is improvement, that is success and we work together to try to maximize that improvement. If you want to have something that is unrealistic, which I doubt, then you will end up disappointed. But if you want to see improvement, and you want to see the particular scars really bothering you improve, bring that to the attention to the doctor, and move forward from that point on.I hope that was helpful, I wish you the best of luck, and thank you for your question.
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Identify scar type, then target acne scar treatments.
See the video link below for a full explanation. Bottom line, you have multiple scar types and will benefit from several sessions of subscision, Infini RF with PRP, fillers etc... Expect a 50% improvement after 5-8 months . Realistic expectations must be met. All the best. (Oh, if you don't want fillers, consider fat grafting to atrophic scars, which maybe visible on angled lighting).
Dr Davin Lim.
Cystic acne scars with elevated scars rolling scars and atrophic tissue loss from the acne scarring process.
Deep Acne Scars
The best combination for your acne scars would be a combination of EMatrix lasers and fillers such as Restylane and Juvederm. Please consult an expert. Best, Dr. Green
Acne scars in Baltimore
Acne Scarring -- Lasers (Fraxel, Co2/Erbium, VIVA, Intensif); Microneedling/PRP, Fillers (Bellafill); Subcision; Punch Excision
Acne scarring needs a series of combination treatments and you will need long term maintenance. Please see an expert in lasers, microneedling/PRP, fillers and subcision. Best, Dr. Emer.
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