What's the best treatment for my acne scars? (Photo)

I had cystic acne 8 years ago and took accutane for half a year and that left me a full face of scars. Besides the atrophic scars, I also have hard scar tissues that are slightly above the surface but not noticeable. However, I can feel them when I touch them with my fingers and they help to form creases when I smile or laugh (plz see the last two pics. They are slightly above the corners of my mouth). I am looking for best treatments to diminish the overall scar appearance. No fillers. Thanks!

Doctor Answers 8

A combination of laser resurfacing and subcision using tumescent anesthesia works best for your type of scars.

I recommend a combination of treatments that include tumescent anesthesia, submission of rolling scars, laser resurfacing, Fraxel Repair or Fotona Fractional Erbium Laser to acne scar areas and punch excision and suture of pitted acne scars.  With this combination of treatment, it is possible to obtain an average of 72% percentage improvement in a single treatment session with about one week of down time.

Salt Lake City Dermatologic Surgeon
4.1 out of 5 stars 17 reviews

A Combination Of Techniques, Rather Than "A One Size Fits All" Approach Is Best For Treating Acne Scars

As is usually case, your photo demonstrates a mix of scars, including pit (ice pick) scars, rolling scars, boxcar scars and possibly elevated hypertrophic scars. There is also some suggestion of generalized cheek volume loss, which may be contributing to the elevations you are seeing near your mouth. If indeed there is volume loss, I would first begin by volumizing the area beneath it with a volumizing filler, which by itself can help to elevate and stretch the overlying scars, and may even reduce the elevations you are seeing with smiling. For this purpose,  in my Upper East Side Manhattan office, I would opt for Voluma XC, while in my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are commercially available, I would opt for Stylage XXL. If hypertrophic scars indeed are present, these may be flattened with the injection of an antiinflammatory agent, such as triamcinolone acetonide suspension. Atrophic (indented scars), i.e. the rolling and boxcar types, can be treated with subcision to raise them up with or without the addition of a lifting filler, both for its immediate lifting and for its biostimulatory effect (to promote new, native collagen and elastic fiber synthesis). My choice would be Restylane Lyft (NY) and Hyaluronica 2 (Israel). Pits and very dilated pores may be treated with The TCA CROSS Technique, using either full strength TCA or phenol; rolling and boxcar scars may be improved with subcision followed by microneedling. Tiny droplets of Botox may be placed in a grid fashion throughout the pitted area to achieve additional improvement. I have not been impressed with expensive fraxels, radiofrequency or ultrasound devices, which are proving themselves to be backed far more by device manufacturer supported marketing hype than hard science. For more information on any of the above, you may check out the archives of RealSelf.com and be certain to consult wtih a board certified aesthetic physician with experience and expertise in treating acne scars. Be particularly cautious about places interested in hawking some relatively expensive one-size-fits-all,  "next best thing" device to come along. Hope this helps. Good luck.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 26 reviews

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.


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​Cystic acne scars with elevated scars rolling scars and atrophic tissue loss from the acne scarring process.

Cystic acne scars with elevated scars rolling scars and atrophic tissue loss from the acne scarring process. For elevated scars some of those scars need to be reduced through ablation with a laser. What that means is that we would destroy part of that elevation with the use of lasers. For the rest of your tissues you can treat it from the surface of the skin. You have to treat the deeper layers in order to get the best result. We have a 5-7 step process that treats all types of acne scars in one treatment in about 2 hours.

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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

I would see Dr. Kontis in Baltimore and get treated with the Infini. It is a great treatment for acne scars. You might need filler as well to get the best results. Dr. Kontis will take care of you. 

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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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Fraxel is a laser skin rejuvenation treatment that resurfaces your outer skin, erasing imperfections. It also encourages the production of collagen, a protein found in connective tissue.The result is clearly visible lines, folds and wrinkles. Fraxel laser skin rejuvenation is a non-invasive technique that affects only about 20 percent of the facial skin exposed to it. The most common side effects of Fraxel laser treatment are swelling and skin redness, which should subside within a couple of days. Other temporary side effects may include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. The risk of infection or scarring is very limited. You should stay out of the sun 2-4 weeks.

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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.