Which skincare procedure would be best for texture and indented scarring on face? (photos)

Question

I am looking for a cosmetic procedure that will improve the texture and indented scarring on my cheeks. When wearing makeup it is very noticeable (see pictures). I am considering microneedling, laser treatment, or a chemical peel but I am not sure which would be best. Any input is greatly appreciated!

Daniel Barrett, MD · Answer

Dear emskieskimo,large pores and acne scarring can be treated effectively with combination therapy. I would suggest coming in for a consultation to see in person but generally speaking we've had great success with a combination of microneedling, light fillers, and laser therapy.  Topicals and your diet are also important to help control breakouts. Daniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery 
Member, Am. Society of Plastic Surgery

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

David Hansen, MD · Answer

The latest treatments that have minimal downtime is Fractora radiofrequency and is done 3 times at a month apart. The old standby which makes a dramatic improvement is real dermabrasions. Either option is  a good choice.

Patricia Faraz, MD · Answer

Hi Emskieskimo,
There are several treatments available.I would recommend doing a series of microneedling with PRP treatments, scheduled 4-6 weeks apart. Microneedling will help smooth out the scars, improve the texture and overall appearance of the skin.
Hope this helps,

Johnson C. Lee, MD · Answer

Thank you for your photo. Your scarring is similar to that of chronic acne scars. There is no one best technology, but the best treatment plan uses a combination of all the things you mentioned. Both Microneedling and fractionated laser or radiofrequency treatments make microscopic holes directly into the scars to stimulate your body to remodel and fill in these areas with new collagen. Chemical peels help boost and even out the thickness of the underlying dermis and aggressively exfoliate your skin for a more blended surface. For the best treatment plan that fits your skin type, it is important to visit an expert for an in-person examination. Hope this helps!Johnson C. Lee, MD Plastic Surgery

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