What type of treatment (fraxel or microneedling) would be best for old, pitted acne scars? (Photos)

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Unfortunately, there is no easy solution for pitted acne scars. I prefer a multi-pronged approach, using Fraxel Re:Pair or another laser (we have more than 40 different types of lasers), microneedling, chemical peels and even excision. Be sure to consult a board-certified dermatologist who has had success improving scars like yours.

A combination approach will give the most improvement. These types of scars need a combination of lasers, microneedling/prp, Cosmelan, TCA cross, punch excision and fillers. Co2 is the best laser for scars, but Erbium is a great alternative. It will take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Hi there,Scarring can be very difficult to treat, Usually it takes upwards up 10 treatment sessions I will recommend alternating between IntraCel-- which is a micro needling and radio frequency with Fraxel. I think this will work best for you. Good luck, Dr. Downie

I prefer microneedling PRP over lasers, however if one is limited to just lasers, than a CO2 is best. Fractions CO2 in your case. I would not use a Fraxel as it is under powered. Lumenis or YouLaser, SmartDot etc... much better than Fraxel. You will also require subcision and possibly dermal fillers to these types of scars. For more on acne scar revision, the resource below explains things in detail. Dr Davin Lim. Brisbane. Australia.