I have a sunken acne scar that needs treatment, hoping to get the different options to fix this. Any suggestion? (photo)

I am looking for a permanent solution for this and not just fillers or temporary fixes. Also to what level can it be fixed, as in can it be fixed to a level its not noticeable.Also need treatment advice for the small acne scars as well.

Doctor Answers 6

Permanent Fix for Sunken-in Acne Scar

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It's hard to tell from the pictures, but you might be a good candidate for subcision to release and raise the scar.  Subcision is a bit more invasive but can offer permanent improvement for the right type of scar.  It works best for rolling scars which are distensible (scars that have gradual edges and look like valleys and which seem to improve in appearance when the skin is stretched).

Acne Scar Treatments

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The best results will be through a combination of eMatrix and injections of Juvderm or Restylane into the scars.  I treat these scars effectively with this combination.  It will take five treatments to improve these deep scars.  Please consult a board certified dermatologist with expertise with acne scars.

Subcision, fat transfer

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If there is tethering, sure, subcision can release any bound down scars. For a more permanent fix for atrophic scars, there is always the option of fat transfer to this area. Fat is excellent as a filler, however it has not got the last bit of finesse that a very fluid filler such as Volbella Juvederm has. This would only matter if you are filling tiny atrophic scars or follicles. 

All the best

Dr Davin Lim 
Laser and aesthetic dermatologist
BRISBANE, Australia. 

Bellafill and Infini are your best choices for long-term acne scar improvement

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Loss of volume with depressed acne scar can immediately be fixed with the permanent filler, Bellafill. Small scars can be improved with the Infini safely in your skin type. These are both long term solutions.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.8 out of 5 stars 52 reviews

Subcision Can Work Well For Permanently Elevating Atrophic (Indented, Depressed, Sunken ) Acne Scars

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Unfortunately, no mature scar can be eliminated entirely. Happily, however, there are methods for significantly improving their appearance and camouflaging and blending them better with the surrounding normal skin.

Subcision, which breaks up the thick fibrous bands of abnormal scar collagen that pull the base of a scar downward, is one such method for permanently improving the appearance of an atrophic acne scar (or, for that matter, any atrophic scar resulting from trauma, prior surgery or infection). By breaking up the tethering bands under the skin and creating a pocket that fills with growth and wound healing factors, subcision promotes new, native collagen and elastic fiber synthesis (neocollagenesis and neoelastogenesis, respectively)--a consequence that results in long-lasting elevation and improvement. (Just fyi: the injection of a small amount of volumizing filler into the pocket can not only give immediate elevation, but may further stimulate new collagen and elastic fiber production). Following subcision treatments, medical microneedling (which also results in long-term improvement) may be used to further help blend the base of the now elevated scar with the surrounding normal skin.

A good number of the scars in the photos provided appear to be ice pick (pit) scars. These may respond to the TCA CROSS Technique, also an approach that typically yields long-lasting, if not permanent results. 

Relatively expensive fraxel lasers, radiofrequency and ultrasound treatments in my experience have unfortunately proven to be far more device manufacturer backed marketing hype than hard science. 

For more information on any of these procedures, check out the archives of RealSelf.com, and be sure to seek consultation and treatment with a board certified aesthetic physician with experience and expertise in the treatment of acne scars.

Permanent fix for acne scars

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In my opinion, for depressed acne scars, subscion is the gold standard .This will give you a permanent result. Often times it may need to be repeated. It's important to wait at least six to eight weeks between each session to see final results.  Lately, I have been combining subscion with Micro needle radio frequency (infini) to give quicker and more substantial  results.  If the scars are superficial,  traditional microneedling with PRP or fraxel restore is helpful. 
Good luck!

Jeffrey Rapaport, MD
Englewood Dermatologic Surgeon
4.7 out of 5 stars 43 reviews

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.