Deep acne scars - what treatment option would be best? (Photos)

Question

I have deep acne scars on my nose and I have tried lots of chemical peels. Did one session of co2 laser and but I don’t see any improvement? Is there any other treatment I need to do, it is really frustrating after spending time and money I’m seeing no results:(

Raffy Karamanoukian, MD, FACS · Answer

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

Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nick Slenkovich, MD · Answer

Hi, I’m Lauren, the aesthetic injector here at Colorado Plastic Surgery Center.

CO2 laser treatment is a highly advanced, non-invasive procedure commonly used for skin resurfacing. It can help reduce fine lines, wrinkles, and other visible signs of aging. CO2 laser is also an effective option for treating various types of scars, including acne scars, surgical scars, and even stretch marks.

As with any aesthetic treatment, it’s important to have a thorough consultation with a skilled provider who can assess your unique skin type, concerns, and goals. Not all laser treatments are safe for every skin type, so choosing a provider who can create a personalized and safe treatment plan is essential for achieving optimal results.

Mahmood Siddique, DO · Answer

For deep acne scars, it’s understandable to feel frustrated if you haven’t seen the results you were hoping for after chemical peels and CO2 laser. While these treatments are effective for many, there are other options to consider for more significant improvement. Based on the treatments offered on your website, here are a few potential options:
Microneedling with Radiofrequency (Morpheus8)- Why it could help: Morpheus8 combines microneedling with radiofrequency energy to stimulate collagen production deep within the skin. This can improve the texture of deep acne scars, particularly when combined with other treatments.- What it targets: It’s particularly effective for deeper scars and uneven skin texture, as it penetrates deeper layers of the skin, promoting the healing and remodeling of scar tissue.- Results: Morpheus8 can significantly reduce the appearance of deep acne scars, improve skin texture, and tighten the skin. Multiple sessions may be needed for optimal results.
Laser Resurfacing (Fractional CO2 Laser)- Why it could help: While you’ve tried CO2 laser already, fractional CO2 laser might be a more effective approach for deeper scars. Fractional lasers work by targeting micro-columns of the skin, leaving surrounding tissue intact and stimulating collagen production.- What it targets: This treatment is designed to resurface the skin, targeting both the surface and deeper layers of the skin, which can improve the appearance of deep scars over time.- Results: Fractional CO2 lasers can help improve skin texture and reduce the appearance of deep acne scars. It may require more than one session depending on the severity of the scarring.
Platelet-Rich Plasma (PRP)- Why it could help: PRP therapy involves using your own platelets to stimulate healing and collagen production. When combined with microneedling, it can help improve scar tissue and promote smoother, more even skin.- What it targets: PRP works to encourage skin regeneration and healing, improving the appearance of scars and helping to restore a more youthful texture.- Results: While PRP may not provide as dramatic results as more invasive treatments like lasers, it can complement other procedures and help enhance overall skin quality.
Dermal Fillers- Why it could help: If your acne scars are particularly deep, dermal fillers might be used to lift the depressed areas of the skin, offering an immediate and non-surgical solution.- What it targets: Fillers can fill in deep acne scars, helping to smooth the skin’s surface and reduce the appearance of scarring.- Results: The results from fillers are immediate, but they may need to be repeated over time.
Combining TreatmentsIn many cases, a combination of treatments may be necessary for deep acne scars. For example, combining microneedling with PRP, followed by laser resurfacing, can address both the surface and deeper layers of the skin, offering a more comprehensive solution.
Next StepsGiven your past treatments, a consultation with a specialist is essential to discuss the severity of your scars and customize a treatment plan. If your scars are deep, a combination of Morpheus8, Fractional CO2 Laser, and possibly PRP could work effectively. These treatments may require a few sessions to see significant improvement, but they tend to yield better, longer-lasting results compared to chemical peels and one-off CO2 laser treatments.
Would you like more detailed information on any of these treatments, or would you prefer to discuss a treatment plan tailored to your needs?

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin in Winnetka and Chicago. This is a great question. It's understandable to feel frustrated and discouraged after investing time and money into treatments for your deep acne scars on your nose without seeing the desired improvement. While chemical peels can offer some superficial resurfacing, they often aren't potent enough to significantly impact deeper, pitted acne scars. CO2 laser resurfacing is a more aggressive treatment known for its ability to address deeper scars by ablating the outer layers of skin and stimulating collagen production. However, a single session may not be sufficient to achieve noticeable results, especially for more severe scarring. The extent of improvement with CO2 laser depends on the depth and type of scars, as well as the energy settings used during the treatment. Often, a series of CO2 laser sessions is recommended to achieve significant improvement. Another treatment option to consider, either alone or in combination with CO2 laser, is Morpheus8. Morpheus8 is a radiofrequency (RF) microneedling device that delivers controlled RF energy deep into the dermis through tiny needles. This dual action of microneedling and RF energy stimulates collagen and elastin production at a deeper level than traditional microneedling or some laser treatments. It can be particularly effective for improving the texture and depth of acne scars by remodeling the collagen and tightening the skin. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

Subcisions, which I have been performing for thirty years with gratifying results is for elevating and smoothing all kinds of indented scars, including boxcar and rolliing acne scars in all locations. Subcision has a several decades' long track record for safety and effectiveness. 
This kind of long track record cannot be said for so many of the expensive, here-today-gone-tomorrow, expensive "bells and whistles" fraxel laser and RF gizmos that are so heavily marketed out there and hawked on social media. So, a heavy dose of  beware beware should be exercised if offered these devices. Medium and deep peels, much like CO2 ablative lasers runs the risk for scarring and dyspigmentation and generally engender prolonged post-treatment downtimes. So caution needs to be exercised when considering these, as well.
You would be wise to consult with a board certiied cosmetic dermatologist acne scar treatment specialist. Hope this helps and best of luck.