29 years old and have all types of acne scarring - what is the best treatment? (photos)

Question

I am 29 years old and have all types of acne scarring on my lower face. I have two quotes. 1 - erbium/dioxide, subcision and CO2 laser to be done about 3 times. another quote I got was for 3 x Infini RF , 2 x TCA CROSS and 1-2 CO2 DOT DAKA Ablative. I have done years of going to walk in laser clinics and having needling and derma pens - nothing has worked. I dont want to waste any more time and money and would love to know what professionals think is best for me.

Raffy Karamanoukian, MD, FACS · Answer

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 HI DEF 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 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 lasers 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. 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
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I'm so sorry that you have wasted so much time and money on lasers and dermarolling. But, unfortunately, I am not surprised. I have been writing RealSelf Q&As for years now warning people about the fact that the relatively expensive, supposedly  "next big thing" bells and whistles lasers out there are really backed far more by device manufacturer marketing hype than hard science. Truly sorry that this had to be learned the hard and expensive way. Likewise microneedling, which I have been performing for over two decades, is really not particularly effective as a primary or monotherapy for acne scars, but can be a wonderful, final, "polishing" step for treating and blending with the surrounding normal skin any residual, superficial color or texture abnormalities that may persist after appropriate acne scar treatments have been performed.  Field subcison can help to diminish any generalized acne-related  atrophy in larger areas, such as the upper cheeks and temples. Following this, individual subcisions can be performed to elevate and smooth boxcar and rolling scars that have not more fully responded to the field subcision. And finally, TCA CROSS can be employed to treat ice pick scars and dilated pores. Subcisons and TCA CROSS, both of which I have been routinely using for well over two decades, can be used safely in all skin types. You would be wise to seek consultation and tried and true treatments by an experienced, board certified cosmetic dermatologist and not simply any venue hawking the latest expensive device it just purchased. Hope this helps and best of luck.

29 years old and have all types of acne scarring - what is the best treatment? (photos)

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29 years old and have all types of acne scarring - what is the best treatment? (photos)

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Everything you need to know about Infini RF

Our mission is to create a world where every investment in modern beauty is Worth It.