Will my acne scars respond to subcision or TCA Cross before I continue with microneedling? (photos)

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

The best treatment for acne scars depends upon an
individual’s skin type, age, ethnicity, sun exposure, overall health and most
importantly, the type of acne scars present (ice pick scars, boxcar scars,
rolling scars, hypertrophic scars and variable degrees of hyperpigmentation).
In order to give you an accurate treatment plan, a consultation is required to
properly assess your skin.

An important step for all skin types is sun protection
including the use of daily sunscreen, sun hats and sunglasses, all of which
help prevent aging and sunburns. 

When it comes to acne scar treatments, a combination of
treatments are available including cosmeceuticals (medical grade skin care
products specific for acne including ZO® Skin Health or ZO® Medical,
Skinceuticals® or Glo-Minerals®), advanced laser resurfacing procedures (CO2
laser, Er:YAG laser, Fraxel DUAL®, PicoSure® FOCUS Lens Array), chemical peels
(light, medium, deep including the blue peel), dermabrasion,
augmentation/fillers, excision and/or subcision, punch techniques,
microneedling/rolling, injections (corticosteroids, 5-FU), cryosurgery,
electrodesiccation and microdermabrasion. 

These are advanced techniques so be sure to get an
experienced dermatologist or plastic surgeon consultation for recommendations
and treatment options.

I can't say for sure without an in person evaluation but I would likely consider TCA CROSS and Microneedling.  Both of these treatments do better when they are repeated more than once.  I have been performing TCA CROSS for over a decade with good results.  Make sure to see an acne scar expert.Regards,Dr. Ort

When treating with infini, typically you need a series of treatments... so I would not exhaust that possibility from just one treatment.There are other laser modalities you can try including fractionated lasers (ablative and non ablative) as well as picosecond lasers.Based on the pictures, I would categorize the scarring as ice pick scars.  TCA cross is a great option, but multiple treatments are needed.I do not think you have rolling scars based on the close up picture you provided. Therefore, I do not think you would respond to subcision.It may be more helpful to see a dermatologist specializing in acne and laser surgery for consultation.I hope this helps.

You are indeed correct, there is no one universal method to classify acne scar types. Some classify according to Goodman scale ( different grades visible at certain distances, but this does not consider angled light), some classify according to scar count, whilst others classify according to subtype- box car, ice pick, rolling etc... Bottom line- almost everyone will have a mixture of scar types. See video below for how to examine and best target your scars. For the best results, one
should target the acne scar type with ideal treatments. For example deep ice pick
scars, and narrow box car scars can be treated with TCA CROSS peels, mixed
scars, rolling, and atrophic scars treated with fractional devices such as
Fraxel, fractional lasers, and INFINI radiofrequency. Atrophic scars
(depressions) can be treated with either fat grafts, or with HA dermal fillers.
Tethered and anchored scars are best treated with surgery.

The majority of patients
will have a collection of different scar types, and hence a tailored treatment
METHOD will be best. Careful examination, especially under angled lighting with
scar mapping will give you an understanding of what are the best options for
your scars.

All the best,

Dr Davin Lim

Laser, surgical &
aesthetic dermatologist

Brisbane, Australia