What is the best filler to use for acne scarring with subcision? (Photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

First, let me say that there is absolutely no surprise that you did not have much result from the microneedling. I have been performing manual microneedling (no need for the added expense or risks of RF microneedling) for nearly 24 years. Microneedlng is an excellent, final "polishing" step for superficially blending otherwise treated scars, in both color and texture, with the surrounding normal skin. It is not a particularly good monotherapy for scars, as you unfortunately have already found out the hard way. I have been performing subcisions for elevating and smoothing boxcar and rolling acne scars since 1995. It has an excellent, proven track record for both safety and efficacy in all skin types (which cannot be said for all the fancy and expensive energy-based gizmos being hawked out there, such as fraxel lasers and RF devices.. I typically do use a filler to complement the subcision, although I do not use permanent fillers, such as Bellafill or silicone, since permanent fillers can translate into permanent or long-lasting problems even five, ten or twenty+ years later. I also do not use Sculptra or Radiesse any longer, since these semi-permanent fillers also cannot be dissolved away should there be any adverse reactions. Instead, I use the much safer HA fillers, which we have learned over the past fifteen years or so ALSO have biostimulatory properties, but can be dissolved if ever necessary. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar specialist. And, one more piece of advice. Don't go into any consultation telling the doctor what you want or what you've learned from Drs. Google and Instagram because you may just get what you asked for. Hope this helps and best of luck.