How do I diminish acne scarring? (photos)

I'm 37yrs old, and I no longer have breakouts as I used to when I was a teenager. However, I have significant scarring. What would be the most effective treatment to diminish some of the scarring?

Doctor Answers 7

Most effective treatment(s) for acne scarring

The successful treatment of acne scars often requires a multi-faceted approach. You have significant atrophic acne scars of mixed pattern. I would start by injecting any shallow and distensible scars with a long acting filler like Bellafill. The treatment takes only a few minutes and the results are immediate and sustained. At the same time, I would release the deep and non-distensible scars that are  "bound down" to the deeper tissues using needle subcision . Release of tethered scars with needle subcision results in a small amount of sub-dermal bleeding that stimulates collagen formation and elevation of the scar long-term.  If ice-pick type scars are present, I would also consider simultaneous TCA-CROSS treatment of those scars.  

At the next treatment session, I would use a deep fractional CO2 laser to correct textural irregularities at the surface and to stimulate the replenishment of damaged collagen and elastin in the dermis. In some patients, especially darker skin types, I prefer fractionated needle radiofrequency (Fractora) as an alternative to laser. Fractora RF has the advantage of reduced healing time and is a much more color safe device.  Finally, if redness and inflammation are present, I would consider a vascular lasers or BBL devices to reduced redness and inflammation. Best of luck.

Saint Louis Facial Plastic Surgeon
5.0 out of 5 stars 112 reviews

Treating Acne Scars

Thank you for posting the photos of your scars.  From the photo it appears that you would need several treatments to minimize these scars.  It is difficult to tell from a single photo but you would benefit from either Fraxel or eMatrix lasers.  Both lasers work extremely well at improving acne scars.  For the best results please consult a board certified dermatologist with a great deal of experience with lasers and cosmetic dermatology.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 75 reviews

Acne scars on the face using a combination approach

Our office specializes in difficult acne scars. I would use a combination of Ematrix RF, fractional laser, subcision, non-ablative laser, TCA Cross, micro-needling, and acne surgery. These will significantly improve your scars. You may require some filler in addition. 

Dr. Karamanoukian 
Los Angeles

Raffy Karamanoukian, MD, FACS
Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

You need a cosmetic dermatologist who specializes in acne scarring/pigmentation and does a combination of treatments including: surgery, subcision, or TCA cross for deep or pitted "ice pick" scars; fillers like Bellafill or Sculptra or Radiesse for broad "boxcar" or "rolling" scars; Eclipse Micropen for all types of scars and improvement in texture and tone; lasers such as co2 laser resurfacing or Fraxel/Clear+Brilliant or radiofrequency such as Sublative or Viva to improve the scars and give long term collagen production. There are many options but you want someone who can customize a regimen for your short and long term goals based on your individual situation. Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 191 reviews

Acne scarring

So sorry you are suffering with this scarring.  Difficult problem.  Improvement is the goal.  I too like the CO2 laser.  I use an Active and Deep FX combo which I find effective.  We also like the Viva for milder acne.  Treatments are less invasive and therefore recovery times shortened.  Good luck. 

David Marcus, MD
Santa Rosa Plastic Surgeon
4.9 out of 5 stars 33 reviews

Skin type, scar type, down time....factors to consider.

To simplify acne scar revision, I consider 3 factors to come up with a treatment program. Your skin type (skin colour), your scar type (in your case you have rolling, atrophic, mixed and possibly tethered scars), and the down time permitted. 

With the two limited photos my plan is as follows-

Fractional laser- CO2 is my preferred, even in dark skin types. 3-5 sessions. 

Subcision during, or after CO2 for tethered scars

Dermal filler at the end for atrophic scars. 

Realistically a program like this takes a year to complete, but gives the best long term results. 
For an in depth explanation of acne scar treatments review my before and afters- note, each case is unique, and a tailored program will give you the best results by far. 

All the best

Dr Davin Lim 
Laser & Aesthetic Dermatologist

Davin Lim, MBBS, FACD
Brisbane Dermatologist
4.7 out of 5 stars 75 reviews

Acne Scars – Combination of Treatments Needed

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, interferon, 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.

Alim R. Devani, MD, FRCPC
Calgary Dermatologist
4.9 out of 5 stars 14 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.