Best treatment for my acne scars? (Photos)

Hello I suffer from acne scars and I would like to know my options. The dermatologist I went to see, recommended punch excision and microneedling. He has no previous experiences with TCA Cross so that was out of the question. I definitely want to get something done but I'm overwhelmed with all the options. I would really appreciate if you could have a look at my scars. What would be the right procedure for my type of acne scars? Thanks!

Doctor Answers 6

Punch excision can substitute TCA CROSS for some more.

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For the best results, one should target the acne scar type with ideal treatments. For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgery.

In you situation, TCA CROSS can be substituted for punch excise using a 1-2 mm punch device, depending on the size of the deep scars. You will also need an energy device such as laser or RF, and finally fillers for the atrophic scars. 

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars.
All the best,
Dr Davin Lim
Laser, surgical & aesthetic dermatologist
Brisbane, Australia

Principles For Treating Acne Scars: Reflate Sunken Cheeks; Lift Indented Scars; Fill Pits: Blend Surface Tone & Texture

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As can been seen in your photos, acne scars comes in various forms and combinations. Accordingly, an individualized treatment plan must be developed based upon the precise types of scars present, their number, and their specific locations.

Therefore, a one-size-fits-all approach so often recommended these days to treat them, such as "fraxel lasers to take care of everything," simply does not make sense and can be expensive to boot. The same applies to a lot of other overly hyped devices, like microdermabrasion, radiofrequency, ultrasound and IPLs--all of which are backed far more by device manufacturer and physician marketing hype than any real, hard science.

On the other hand, some considerably less expensive approaches have been shown to be tried and true, including volumization with injectable volumizing fillers to reflate sinking cheeks; subcision with or without fillers to raise up indented (atrophic) scars; TCA CROSS to tighten pit (ice pick) scars; and fractional microneedle resurfacing (aka medical microneedling)) to blend surface color and textural irregularities. Punch grafting and punch excisions are occasionally of value for certain deep boxcar-type scars, however, these techniques are performed much less frequently these days than twenty years ago.

Seeking consultation and treatment by a board certified aesthetic physician with expertise and experience in treating all forms of acne scars, even if it means traveling out of your town,  is strongly advised. Best of luck to you.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Many opinions and options for acne scars

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You have some rolling and ice pick scars. I would use the Infini about 3-4 times. After that, remaining deeper scars can be treated with Bellafill. I have tried lasers and feel Infini is superior to these. See link.

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews

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TCA CROSS and Laser

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Your icepick scars should respond well to 2-3 sessions with TCA CROSS but punch excision is a reasonable alternative also.  Following that and once you have healed, I would follow it up with fractionated CO2 or my favoured ablative erbium + fractionated co2 laser combo which usually yields great results.

Best wishes, Shobhan.

Laser treatments for acne scars

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You can always get a 2nd or 3rd doctor’s opinion before proceeding with the treatment plan you are most comfortable with. If you find a treatment you want to do, it’s also best to find a doctor that is familiar with using the treatment and can provide you with some before and after photos. There are currently two laser treatments that will help for your acne scars. Affirm CO2 Fractional Laser and the PicoSure laser.

The Affirm CO2 Fractional Laser is a micro ablative treatment with a wide-range of settings for “incredible flexibility”. For acne scarring, depending on scar depth, four to six sessions may be necessary, at two to three week intervals. Patients can expect anywhere from 60% to 80% clearance. There is probably two days of downtime with redness and swelling. However, the results are likely permanent.

The PicoSure laser is gentle on your skin, with minimal discomfort or downtime after treatments. PicoSure works by sending ultra-short pulses of laser energy into the outer and inner skin layers. This helps dermatologists effectively treat the outer skin, while the laser also stimulates collagen and elastin production within the inner skin layers. The PicoSure laser can be used to help treat acne scars through the following:
  • Reduce damaged and scarred skin
  • Reduce dark spots
  • Shrink glands that produce oil
  • Encourage collagen and elastin production
To find out which one would be best for you, you have to schedule an in-person consultation with a qualified dermatologist.

Bruce E. Katz, MD
New York Dermatologic Surgeon
3.8 out of 5 stars 17 reviews

Acne Scars

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The best treatment for these acne scars would be a combination of fillers and lasers such as Fraxel.  Please consult a cosmetic board certified dermatologist with experience with these advanced techniques.  Best, Dr. Green

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.