What Would You Recommend to Get the Best Result for my Acne Scars at This Point? (photo)

I've already had Fraxel laser done and spent 3.5K without being 100% happy.

Doctor Answers 3

Best Result for Acne Scars

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The type of acne scars that you have tend to respond well to laser resurfacing treatments.  The most dramatic improvement of acne scars can be seen after treatment with the Fractional CO2 laser.  This is different than the Fraxel Re:Store in that it is an ablative laser; this means that the surface of  the skin is ablated and healthy collagen is produced by the laser to produce a smoother skin surface.  We have developed a technique called the FAST technique for acne scars, that judging from your photos, would be an excellent treatment option.  The FAST technique is used to treat focal areas of acne scarring, rather than acne scars that cover the entire face.  By treating only a localized area (such as the cheeks), we are able to use stronger settings to get more dramatic improvement, with shorter downtimes.  It may be an option that you wish to explore.  

Other treatment options include subcision, dermal fillers (though most are not permanent) and certain types of chemical peels.

New York Dermatologic Surgeon

Acne scars

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It looks to me as though most of your scarring is in a localized area on your cheeks.The options you could consider would be 1) more Fraxel 2) Dermapen 3) subscicion 4) CROSS chemical peels.  Each of these have their advantages and disadvantages and more than one treatment would be required with either.  I'd recommend you discuss these options with your dermatologist.  Good Luck.

Peter J. Jenkin, MD, FAAD
Seattle Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Acne Scars - Treatment Options

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Hi Tsveta.  It's important to consider a solution for acne scars in the context of realistic expectations.  Fractional Laser resurfacing is an excellent option for your textured acne scars, but a key issue is that it is very difficult or more likely impossible to remove them completely.

With that said, there are very different approaches to acne scar resurfacing and knowing what kind of laser was used is a starting point, but the depth of penetration, the coverage and the anesthesia used give us a better idea of how well the procedure was done.

In our practice, we use everything short of general anesthesia for our resurfacing procedures because to go deep (and get better results) it would hurt a lot without these measures.  We use dental blocks (the kind that make your lips and cheeks numb), numbing cream and Valium and Vicodin.  If we did not use all of these, the patients would not be able to get through the treatments.  The key here is that deeper treatments are more painful, but also lead to much better results.  We resurface down in the 700-1000 micron range on the cheeks (down to 1 millimeter depth) and doing so allows us to soften up deeper scars.  It would be interesting to note the setting with the MD that did the Fraxel to get a comparison.

Also, our procedure requires about 1 week of recovery (regeneration of the skin) and then up to 1-2 weeks of redness may follow.  

If the anesthesia procedures or recovery were very different for you, then you may have received a laser resurfacing procedure that is less than optimal for your situation. In this case, contact another office to do a deeper resurfacing.  We typically do this 2-3 times with the Sciton Profractional laser at a cost of $1,500 (2013) for each visit.  Good luck.  

Harold J. Kaplan, MD
Los Angeles Facial Plastic Surgeon
4.4 out of 5 stars 7 reviews

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.