How do I treat these tethered boxcar scars? (Photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

you will need a combination of lasers, subcision and fillers. TCA cross for small ice pic scars. dermarolling twice weekly.

at home peels like cosmelan, enlighten and aerify along with dermarolling (Emerageskin roller with anteage MD AERIFY ampules weekly) should be started now (see link to emeragecosmetics).

if you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream.

Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, halo, maxi, pro fractional laser/erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer. 

I have treated many hundreds of patients with atrophic/depressed boxcar scars with nice results. Typically multiple treatments are required, and multiple modalities. Treatment options depend on many factors including age, skin type, previous treatment experiences, budget, downtime, extent and location of scarring, pain tolerance, etc; It most certainly is not 1-size fits all and requires a proper in-person assessment by a scar expert such as a dermatologist. It is also key that your acne is under good control and/or in remission. I believe that subcision, often with fillers, is a great way to start, followed by subcision alone (usually every 6-8 weeks). Laser resurfacing such as ErYag (Profractional) or CO2 fractionated lasers is also an excellent option, again several sessions (usually every 4-6 weeks). Medical grade & deeper chemical peels can also be helpful, whereas microdermabrasion isn't so helpful. I also very much like microneedling (medical-grade, deeper, although home devices can help a bit too), especially when boosted with PRP (platelet-rich plasma) or RF (radio frequency). For stubborn scars not sufficiently responsive to aforementioned treatments, we do punch excisions. For thicker/keloid/hypertrophic scars, we do cortisone or cortisone-mix injections. Best to chat with your local dermatologist who has the most experience and training in treating both acne and acne scars.