Sculptra for acne scars?

Question

Hello hoping I can get some opinions on sculptra. I've been recommended it as an option for my acne scars by a doctor I have had needling and prp. I have tried lots of treatments including non invasive laser, co2, needling with not much improvement and some cases new scars and worse skin. I feel like my collagen has broken down which has resulted in sunken cheek on one side and box scars on the other. Any comments on whethe this will help is appreciated. Can I combine with needling also?

Kimberly Butterwick, MD · Answer

Deep acne scars can be very difficult to treat, as you’ve experienced with multiple treatments. You’re right, the inflammation of acne does break down the collagen and elastic fibers. The treatments you’ve had should have helped, but may need to be deeper. I like the Infini microneedling system for acne scarring because it can go deeper and the needles deliver radiofrequency at the tip. A fractionated laser can also reach this depth. For the sunken appearance, volumization with filler would help to lift the cheeks. This will also help to stretch the skin and make the scars more shallow. Useful fillers for volumizing are Sculptra, Voluma, Restylane Lyft or Radiesse. For surface scars, I prefer a soft filler like Belotero, which won’t show through when superficial placement is needed. In skilled hands, other fillers are sometimes used, like Restylane Silk, Volbella or Bellafill. If you’re not getting the results you want, please find a board-certified dermatologist who has expertise in scars, as your case is complicated.

Michael I. Echavez, MD · Answer

When acne scars on the surface of the skin are located under an area that is sunken in, adding volume to the sunken area can improve the appearance of the scars.  Sculptra can work well in this situation.  There are also additional treatments that can be done to the scars themselves at the surface of the skin, some of which you have already tried.  Sometimes scar revision can help as well.  Bellafill can be helpful when injected directly into certain types of acne scars and has long lasting effect.

Nelson Castillo, MD · Answer

Thank you for sharing your question.  You can combine Sculptra with needling as part of on ongoing acne treatment, and Sculptra works well to restore the volume loss component of acne that tends to make scars look worse.  I would recommend you look into a product like Bellafill for a longer term solution for your scarring.  Hope this helps.

Richard E. Moore, MD · Answer

Thank you for your question. While Sculptra Aesthetic does not have FDA clearance for the treatment of acne scars, I have seen some patients who have gotten a nice improvement. In your situation with the sunken cheek it may be a nice adjunct to your other treatments. Consider the addition of Bellafill for the treatment of your acne scars as well. This gives a much longer lasting result than any other dermal filler. The Sculptra can be combined with micro-needling, laser resurfacing, and the RF needle devices like Fractora.I hope this was helpful - Dr. Moore.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Agree with Dr Butterwick, different fillers for the amount of atrophy and finesse. Sculptra maybe an indication- I use this filler for extreme atrophy, whilst I utilise HA fillers for finesse. 
Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help.

As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

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