Does microneedling work for indented scars ?

Microneedling can help but indentated scars need subcision and fillers.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, 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.  Best, Dr. Emer. 

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

I have been using medical microneedling for about twenty years already. Although I know that it is marketed for the treatment of deep, sunken (atrophic, indented, depressed) scars from a variety causes, such as post-acne, post-trauma, post-surgical and post-infectious (like chickenpox), I really do not believe it a first choice for any of those indications. Rather, I have found it to be particularly helpful following other treatments for dealing with persistent redness or hyperpigmentation (postinflammatory erythema, postinflammatory hyperpigmentation) and even for treating postinflammatory hypopigmentation, as well as other causes of pigmentary loss. As anyone who has regularly read my answers would know, I am hardly surprised that you achieved little success with radiofrequency microneedling, since radiofrequency devices, fraxels and other relatively expensive energy-based devices are far more backed by device manufacturer supported marketing hype than hard science. Subcision, about which you can read more in the archives of RealSelf and which I frequently use, is a quick, simple and relatively inexpensive technique for elevating all kinds of sunken scars that has a proven track record going back about a quarter of century. Make sure that you consult with a board certified aesthetic physician and ask to see his/her personal befores and afters before agreeing to plunk down any more money on supposedly "next big thing" devices. Best of luck.