Can anyone explain how Belotero should be injected so it does not create a donut hole around an acne scar?

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.
- Subcision for depressed, tethered scars.
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring.
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Picking the right acne scars for dermal injection is key in preventing this "donut hole" that you are describing. Scars that are tethered need to be released with subcision before dermal injection to give you the optical outcome.Best H Karamanoukian MD FACS

Dear fory06:  From your description, it seems likely that you have bound-down acne scars. Treating these requires one or more of several specialized approaches. You could have #microneedling with #PRP with subcision of the acne scars that are bound-down.  Another option would be injecting them with #BellaFill, which is a more permanent filler, combined with subcision at the time of injection of the filler. #Beletero can improve scars that are depressed but not bound-down or tethered to the underlying connective tissue.You might consult with a board-certified dermatologist who employs these and other modalities to treat acne scars, for the best results.  All the best, Dr. Clark

Hello, and thanks for your question. Sorry you have not yet gotten the results you had hoped for.Belotero can be a great filler to use for acne scars for the reason you have alluded to -- it is a thin, forgiving filler that can be placed very superficially. This is great for superficial scars, but for deeper ice pick and box scars, this is generally not sufficient, as these scars are more bound-down and have fibrous adhesions. Another downside is that Belotero tends to not last as long as other fillers. I generally use a combination of fillers, subcision, lasers and/or TCA CROSS to get the best results for my acne scar patients. Every patient is different and therefore needs a customized plan. In my opinion, this is most certainly an area where having a "cookie cutter" approach will result in sub-optimal results for many patients. In order to determine the best treatment plan for you, I recommend an in-person consultation with a well-trained dermatologist. Make sure your doctor closely examines your scars before recommending a specific treatment plan. Best of luck, Dr. Frucht.   

My two favourite products for filling acne scars are with Belotero or with Juvederm VOLBELLA. I use many techniques with fillers for acne scars, including subcision, tunnelling as well as the inverted pyramid - will produce a video on these methods in the near future. But to answer your question- yes, using subcision a good injector can fill acne scars without lumps. See the YOUTUBE video for more info. Dr Davin Lim, Brisbane. Australia.