Age 29, male, cystic acne - What treatment is best?

When considering treatment options for cystic acne scars, especially with a history of facial strokes and concerns about potential side effects like fat loss and sagging, it's important to have a comprehensive and personalized treatment plan. Here are some potential options to discuss with a dermatologist or a cosmetic specialist:

Microneedling: Since you have seen improvements with microneedling before, this could be a viable option to continue. It can improve skin texture and reduce the appearance of scars with minimal risk of causing facial sagging.

Laser Treatments: Fractional laser resurfacing, such as CO2 or erbium lasers, can be effective for acne scars. These treatments stimulate collagen production and improve skin texture. However, it's crucial to discuss any concerns about fat loss or sagging with your provider, as deeper treatments can sometimes affect the skin's structure.

TCA Cross: Trichloroacetic acid (TCA) cross is a chemical reconstruction technique specifically for ice pick scars. It can improve scar depth by stimulating collagen. This method is localized and typically does not affect surrounding skin in a way that would cause sagging.

Subcision: This procedure involves breaking the fibrotic strands beneath the skin to lift depressed scars. Subcision is often combined with other treatments like fillers to improve results and minimize the risk of sagging.

Dermal Fillers: Temporary fillers can be used to improve the appearance of deep scars and address any volume loss. This can also help counteract any asymmetry due to previous strokes.

Radiofrequency Microneedling: This combines microneedling with radiofrequency energy to enhance collagen production and improve skin texture. It is generally safe and has a low risk of causing sagging.

Given your medical history and specific concerns, it's crucial to work closely with a dermatologist who can evaluate your skin and tailor a treatment plan to your needs. They can also provide guidance on the risks associated with each treatment and help monitor your progress to ensure optimal results.