Acne scar Hyperpigmentation - What kind of treatment should I try for my problem? (photos)

Question

Gender. Male, Age:40. Skin: Brown. Have acne hyperpigmentation as shown in the pics. Effectively, I had acne for a long time on these 2 spots which after a few years turned into dark spots. Tried laser treatment 2 times. Skin looks good for a week after laser, but returns back exactly to what it was before after a few weeks. Does my skin have memory so as to return back to this color? What kind of treatment should I try for my problem. Is skin surgery a good option? Thanks a lot!

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

The PIH (post-inflammatory hyperpigmentation) problem in the photo is a fairly common one. In my experience, this type of brown spot shown typically responds to a series of in-office superficial chemical peel treatments, such as high concentrations of glycolic or salicylic acid, Jessner's solution, or TCA in concentrations of 25 to 35%, accompanied by the at-home application of prescription topical bleaching agents. For more resistant cases, the addition of a series of professionally performed Dermastamp microneedling sessions alternating with the superficial peels may be needed. I would be cautious with the use of lasers and other energy-based devices as these risk the development of hyperpigmentation, particularly in skin of color. You would be wise to consult a board certified cosmetic dermatologist. Best of luck.

Acne scar Hyperpigmentation - What kind of treatment should I try for my problem? (photos)

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Acne scar Hyperpigmentation - What kind of treatment should I try for my problem? (photos)

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Everything you need to know about Laser Scar Removal

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