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

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

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.