Are chemical peels a permanent solution to acne scars? (Photo)

I have written this many times before. especially when it comes to the treatment of acne scars, treatment should not be a "one size fits all" approach. There are a number of different types of acne scars, as can readily be seen in the photo provided here, so it really is not reasonable (despite the marketing hype for fraxel lasers and ultrasound devices, etc.) to expect one technique to do everything. In general, superficial chemical peels, since they are so superficial (and acne scars are deep) can be expected to do little more than refresh the skin and make it more glowing. So, this is not an appropriate option for actually treating the scars. Deep peels, whose significant downtime, make them more resemble more invasive surgical procedures like dermabrasion, and carbon dioxide ablative lasers, have certainly been shown to be effective for some types of scarring. But, as I mentioned, the downtime is much like after a surgical procedure and the risks of scarring from the procedure itself and of hyperpigmentation and permanent loss of skin pigmentation afterward are significant. Fraxel laser results tend to be variable and inconsistent and in my opinion not worth the considerable expense, despite all the device manufacturer backed marketing hype.An approach to acne scars that takes into consideration the characteristics and needs of the individual types of scars present in my opinion is a far more reasonable way of addressing the problems. For example, rolling scars may be individually treated with Subcision, with or without the concomitant treatment with fillers. Box scars may be treated with subcision below them to free them up and focal manual dermasanding to smooth the boxy ridges on the surface. Pit scars can be individually treated with a "fraxelated" high concentration peel approach known as the CROSS technique. And finally, the tone and texture of the surface of the treated skin can be better blended with surrounding normal skin via medical microneedling. The gains achieved by subcision, medical microneedling and the CROSS Technique are permanent.For more information on any of the above, I suggest you check out the archives of Realself.com. Consultation with a board certified aesthetic physician with knowledge, experience and expertise with all forms of acne scar treatments is strongly advised. 

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

There is no cure for acne scarring, but you can get major improvement.  You need a cosmetic dermatologist who specializes in acne scarring/pigmentation and does a combination of treatments including: surgery, subcision, or TCA cross for deep or pitted "ice pick" scars; fillers like Bellafill or Sculptra or Radiesse for broad "boxcar" or "rolling" scars; Eclipse Micropen for all types of scars and improvement in texture and tone; lasers such as co2 laser resurfacing or Fraxel/Clear+Brilliant or radiofrequency such as Sublative or Viva to improve the scars and give long term collagen production. There are many options but you want someone who can customize a regimen for your short and long term goals based on your individual situation. Best, Dr. Emer.

  As I have written many times on this forum, there are hundreds of types of chemical peels and hundreds of types of lasers for the treatment of deep acne scars.  Both involve facial resurfacing and it is not the modality, so much as the depth achieved, which is most important.  Other options include subcission, punch excisions and fillers and usually a combination of ALL of these are necessary to achieve best results.  Your single most important decision is choosing a doctor who will work with you to achieve your best results.