Would subcision or dermabrasion provide the best results for my acne scars? (Photo)

Dermabrasion, whether manual or machine performed, (much like the ablative carbon dioxide laser) is an old standby that was used extensively for acne scar treatment, especially twenty or more years ago, when little else was available. It was a reasonably effective, relatively expensive technique for smoothing the skin, although it was an aggressive approach, which, in its healing downtime was not much different from that following surgery. Fortunately, we have come a long way since that time and we now have several minimally invasive approaches that have proven quite effective and stood the test of time and engender little to no significant downtime. Subcision, as you correctly suggest, appears, at least from the photos, to be a very viable, relatively inexpensive treatment option for elevating and smoothing the deep depressed scars visible in the photo. Some might also suggest the concomitant use of TCA to the base of the scars for further improvement, and, subsequently, medical microneedling, another relatively inexpensive no dowmtime procedure, following the subcisions for blending any residual, superficial surface color and textural irregularities with the surrounding normal skin. Make sure you are consulting with a board certified aesthetic physician, and best of luck to you. 

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 HIDEF 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 been 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 laser 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.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. 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

Thank you for your question.I would recommend a combination of both. I would do the subcisions first and allow at least 2 months to heal, then once they are evened out you can proceed with dermabrasion.