What can I do to minimize the appearance of acne scars? (photos)

Question

Ethnic skin.MIXED tethered acne scars and have tried: -Several sessions of microneedling which actually made scars worse (been playing catch up ever since) - 4 sessions of subscision and TCA 100% cross (without filler) - 1 recent session of subscision, TCA 80% with filler Scars still extremely visible, especially in daylight, of course terrible in angled light depth has improved just tiny but is there also an element of pigmentation that can be removed via a picosure to improve appearance??

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Shanthala Shivananjappa, MD · Answer

I am sorry to know that you have still visible scarring after microneedling, TCA and subcision. Treating acne scars in patients with skin of color can be more challenging, and it make years and several combination treatment sessions. Patients with darker skin tones are more prone to developing hyperpigmentation, keloid formation, and post-inflammatory erythema (PIE) after acne scars heal. That's why energy-based treatments like lasers and RF microneedling have become the gold standard for treating acne scars even for skin of color patients. But it's important to work with an expert physician who's trained in treating skin of color to minimize the risk of complications and knows how to adjust or choose the correct laser for Skin of color patients.  They can also help you explore other options like  Biostimulators such as radiesse and sculptra, subcision, exosomes, and platelet-rich plasma (PRP) therapy, which can enhance the healing process and improve the overall appearance of acne scars.

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