What is the best treatment for severe acne scarring? (Photos)

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.
- Subcision for depressed, tethered scars.
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring.
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

There is little surprise at the lack of efficacy of microneedling as this procedure, which I have been performing professional for twenty-two years is not a particularly useful monotherapy for acne scars and is best reserved for better blending residual superficial surface texture and color irregularities within previous treated areas (by another modality, like subcision) with the surrounding normal skin. At least from the photos provided, individual subcisions would seen to be indicated, especially for elevating and smoothing the larger, deeply depressed atrophic scars. No mention is made of how many treatment sessions were performed. I have been performing subcision with gratifying results since 1994 and have found that in general that anywhere from two to six treatment sessions may be required at each site to achieve somewhere between a 60-80% overall improvement in appearance. What's more an HA filler (not a permanent filler) may be additionally used for its ability to encourage new collagen and new elastic fiber synthesis to supplement the subcision. You would be wise to make sure you are consulting with an experienced, board certified cosmetic dermatologist with experience and expertise in acne scar treatment. Best of luck.