I do a combination of laser or radiofrequency, fillers, TCA cross and subcision. Best, Dr. Emer.
In general, depressed scars, such as boxcar and rolling scars, need to be elevated, and subcision often works well for these. The supplemental use of certain fillers immediately under the base of the scars can not only augment the elevation and provide immediate improvement, but can also play a biostimulatory role by promoting new, native collagen and elastic fiber synthesis (neocollagenesis and neoelastogenesis, respectively).
Pit (ice pick) scars respond well to The TCA CROSS Technique.
Further smoothing may be obtained by the use of a volumizing filler injected under the entire scarred area, below the scars, to stretch them and make them more shallow and less shadowed.
Finally, fractional microneedling using manual or automated devices may be employed to help blend the tone and texture of the treated scars with the surrounding normal skin. Very shallow scars likewise can respond well to this approach.
All of the above approaches have been safely used in Asian skin.
As an aside, I am not much of a fan of fraxel lasers nor of radiosurgical devices, finding these relatvely expensive approaches to be far more backed by device manufacturer supported marketing hype than hard science.
You would be wise to seek consultation with a board certified aesthetic physician with particular experience and expertise in acne scar treatments.
I have had great results with eMatrix in treating Asian skin with minimal downtime. You will need at least three sessions but you should see continued improvement after each treatment. Best, Dr. Green
Scars need to be evaluated in person to see how the skin moves. Asian skin is very responsive to fractionated resurfacing but need to be treated conservatively with a low density of 5.5 per cent on the Sciton joule to minimize hypopigmentation.
Fraxel is a laser skin rejuvenation treatment that resurfaces your outer skin, erasing imperfections. It also encourages the production of collagen, a protein found in connective tissue.The result is clearly visible lines, folds and wrinkles. Fraxel laser skin rejuvenation is a non-invasive technique that affects only about 20 percent of the facial skin exposed to it. The most common side effects of Fraxel laser treatment are swelling and skin redness, which should subside within a couple of days. Other temporary side effects may include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. The risk of infection or scarring is very limited. You should stay out of the sun 2-4 weeks.
In my opinion, based upon the photos, I think that you have deep saucer as well as superficial saucer-shaped cars and box cars. The treatment for these types of scars include subcision, microneedle radio frequency (infini ) and radio frequency, and non-ablative lasers. Should the scars be distensable upon pulling the lateral edges of the scar, fillers are also an option. Pre and post treatment with bleaching creams are important for Asian skin. There exists fillers that have 5 years duration as well as more natural fillers that will last two to three years. I tend to avoid the permanent fillers . I feel that permanent fillers can lead to permanent problems. Multiple treatments will be necessary. Seek a dermatologist or skin specialist who has experience in treating acne scars. Ask to see photos. Hope this helps. Good luck.
I would start with RF - radio frequency micro needling with insulated needles- INFINI RF. This is a good treatment as it does not involve laser energy, hence with your skin type, the chances of skin colour changes are virtually nil. More on the device in the link below. (second half of video).
You will also require subcision, and dermal fillers. You can expect a good improvement, however with your scar type, several methods must be used.
Dr Davin Lim