What treatment would be best for my acne scar? (photos)

Question

What treatments do you think would be best for treating my acne scars? Would I be a good candidate for co2 laser or maybe TCA cross? I am trying to get an idea of what I need as all the providers near me offer different treatments and I'm not sure which one to choose. Thank you!

Raffy Karamanoukian, MD, FACS · Answer

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

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).

Ifyou 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.

Nelson Lee Novick, MD · Answer

TCA CROSS, a relatively quick and inexpensive technique, has been used safely and effectively in all skin types for well over two decades for the treatment of ice pick scars. The same cannot be said for most of the relatively expensive bells and whistles lasers and other energy-based devices whose heavily marketed and hyped claims for success lag well behind the hard science to substantiate them. So, make sure that you consult with an experienced board certified cosmetic dermatologist with extensive scar experience. Best of luck.

Sheryl D. Clark, MD, FAAD · Answer

Hello angelicai:

In these photos, it appears that most scars are pitted. There are a few boxcar scars as well. This type of scarring responds best to Microneedling with PRP and fractionated CO2. Resistant scars can be treated with TCA cross.

It might be best to consult with a board-certified dermatologist with a special expertise in acne scarring and with multiple modalities at their fingertips.

All the best from NYC,
Sheryl Clark FAAD

Gilberto Sanchez Rico, MD - Account Suspended · Answer

Hello!To see a full improvement on your skin you should have a deep cleaning facial following of a treatment combining laser Spectra and laser CO2 fractional in order to reduce the size of the pores and minimize the appearence of acne scars.

What treatment would be best for my acne scar? (photos)

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