Do I need to combine CO2 and Subcision with Sculptra? (Photo)

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

I believe that Subscision and Co2 should work for you. The Subscision needs to be done with a Cannula or elevator. The Co2 at aggressive depth and moderate density. Find a scar expert.
Jeff Rapaport MD FAAD
Realself Hall of Fame

At least from the photo provided there appears to be a significant amount of acne scar-related volume loss in the cheeks, making the overlying predominance of ice pick scars that much more prominent. If this is indeed the case, then a Field Subcision for the cheeks properly performed would most likely lead to significant improvement. Following this, TCA CROSS may be subsequently used, if still necessary, to address any ice pick scars that may remain. I gave up using Sculptra many years ago; it is expensive and typically requires about three treatment sessions to achieve any results. I am also no fan of CO2 lasering, as this approach, much like that of old-style traditional dermabrasion, is a very aggressive approach that risks scarring and leaving the skin with a permanent, unnatural, waxy, orange peel appearance. And also, like dermabrasion, engenders a significant period of post-treatment healing and downtime. You would be wise to make sure to consult with an experienced, board certified cosmetic dermatologist and best of luck.