Would TCA Cross benefit these ice pick scars? Laser? (Photos)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. 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

you will need a combination approach and I find the TCA cross with micro needling RF and/or erbium laser really help this. you can do cosmelan or Reve peels between to help further improve the texture.  Best, Dr. Emer.

Hi, 
I had terrible acne in my 30's after my daughter was born and that resulted in a ton of scarring. I know how bad I felt about it. Luckily, I have had every type of technology available to me as well as skin care over the last 20 years and have tried everything and know first hand what works. You have alot of options that practitioners will offer you so here is the lowdown. 
1. peels- work but not deep enough to get good resolution quickly. You will get about 15% improvement with a few peels done back to back....but OH the downtime.....Save this for the end to get the last 15% of improvement. 
2. Fraxel or fractionated radiofrequency- Doesn't work deep enough, is very painful and lots of downtime. If it is done repeatedly or super aggressively (fraxel which is very old technology) will result in waxy looking skin which you don't want. Newer fractionated radiofrequency treatments like ematrix work better with less pain and less downtime. I think with repeated ematrix treatments you could get 25% resolution. Save this for the end as well to get the last 25% improvement.
3. Lasers- CO2 lasers are the only ones that would work. Too painful, too risky and also leaves the skin looking waxy. Don't waste your time or money. 
4. Micro needling with PRP- This treatment can give you 50-75% improvement or maybe more and combined with fractionated radiofrequency or peels at the end could result in the scars really resolving even more over time. Micro needling with PRP will get to the proper depth and the PRP will really accelerate the improvement and build up the skin in those areas most efficiently. There is very little downtime (2-4 days) and is easily covered with makeup. The micro needling should be done with a motorized pen so as to not rip the skin also allows precise depth of needle penetration which is critical for treating scars.  PRP really maximizes the treatment for you by more than a 50%. It is worth the extra expense. I would expect to do between 3-5 sessions each session done once a month. Creates a dewey look to the skin and regenerates the circulation giving your skin more youthful tone and vibrancy. Good to do on any skin type and any level of acne scarring. 
5. Products- I would definitely use a retinol based product that aggressively stimulates collagen repair by turning on the collagen gene. 
Best of luck
Dr Jamé

Thank you for your question and posting pictures.  No one has perfect skin, but you can probably get significant improvement in your scars.  Some lasers are proven very effective on acne scars.  After a complete consultation in a medical setting, you would probably be a candidate for a several treatment options depending on your skin type, severity of the scar and how much downtime you can take.  Keep in mind that more intense/deeper treatments require more downtime, but you will need less treatments.  If you choose a short downtime treatment plan, you will need more treatments in the series.  The most gentle would be something like the PicoSure FOCUS treatment with almost no downtime for both scars and sun damage.  It is safe for all skin types, but you would probably need 1 to 3 treatments.  Another option would be a fractional 1540 nm laser treatment like ICON or Fraxel.  With these treatment you could have redness and swelling for 1 to 3 days, but need less treatments.  Based on your skin type, you may be a candidate for a fractional CO2 treatment with 7 days of redness and swelling.  Look for a medical setting with a doctor in house, where they have multiple laser options and experience treating your scars.  Prices vary by market.  Best of luck.

In truth, I don't know, photos need to be high resolution with no make up. The best avenue is to see a reputable dermatologist for a real time examination, no make up for 60 minutes BEFORE the appointment. If these are deep scars, sure, TCA can work. I often combine with low density CO2 lasers. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help.
 

As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations.

 

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. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.