What treatment would flatten these acne scars on my nose?

Question

I used to get cystic acne on my nose as a teen and it left hypertrophic (raised bumps) and a few atrophic scars. I have tried using tretinoin and at-home microneedling, but there wasn't any improvement. What treatment could be done to flatten or remove these scars? Could dermabrasion or CO2 lasers work? Thanks.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 acne 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

Randal Haworth, MD, FACS · Answer

I'm sorry to hear that you've been struggling with acne scars. It's important to note that the most effective treatment for acne scars depends on the type and severity of the scars.

Hypertrophic scars are caused by an overproduction of collagen during the healing process and can be difficult to treat. Some options that may help to flatten or reduce the appearance of hypertrophic scars include corticosteroid injections, silicone sheets or gels, and cryotherapy (freezing the scar tissue). If these options do not provide the desired results, your dermatologist may recommend surgical removal of the scar tissue.

Atrophic scars are characterized by a loss of tissue and can also be challenging to treat. CO2 laser resurfacing and dermabrasion are both effective treatments for atrophic scars. These procedures work by removing the outer layers of skin, allowing new, smoother skin to grow in its place. However, these procedures may require multiple treatments and can have a longer recovery time compared to other scar treatments.

Before undergoing any scar treatment, it's important to consult with a board-certified dermatologist or plastic surgeon who can evaluate your skin and recommend the best treatment options for your specific type of scars. They can also discuss the risks and benefits of each treatment and help you make an informed decision.

Best of luck !

Anil R. Shah, MD · Answer

Hello Versatile699

My name is Melanie I am a Medical Aesthetician located in Chicago IL at Aesthetic Skin. You are already on the right track by using Tretinoin. I would suggest completing in a Medical Office a series of Microneedling with Exosomes or PRP 3- 6 treatments 4 weeks apart . Or Co2 also in a series 3 or more may be needed. It will take some time but being consistent with Medical Treatments and you will see improvements. I would love to discuss a treatment plan with you further. Please give our office a call to schedule a virtual or in person skin consultation. 312-944-0117. I do look forward to connecting with you.

Jason Emer, MD · Answer

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in person or virtual consultation to develop a custom and effective treatment plan.  It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

Danielle Shanley, MD · Answer

Hello and thank you for your question. The scars look like they may be keloids. Your dermatologist can inject them to flatten out the scars.

James R. Gordon, MD, FACS, FAAO · Answer

Thanks you for sharing your questions and posting your photos. Acne scars, as you have seen, are difficult to treat. Laser resurfacing can improve the appearance of scars, but the nose is a particularly tough area. See an expert in erbium laser resurfacing for comprehensive evaluation and guidance. Good luck.

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