Which treatment would be better... Skin needling or fraction laser treatment? (photo)

I have moderate "ice pick" scars on both sides of my face. I have ethnic skin. Also, pigmentation from acne (I am taking a bleaching cream every other night for some months now).

Doctor Answers 5

Best Treatment for Scars on Dark Skin NYC

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Neither of the treatments that you mentioned would be as good as eMatrix combined with microneedling and PRP.  eMatrix is "color blind" and able to treat these scars in the most amazing way.  I have treated many patients who were unhappy with lasers such as IPL and Fraxel with dark skin.  Please consult a specialist who understands how to treat dark skin types.  Best, Dr. Green

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

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Ice pick scars need a combination of TCA cross, surgery, lasers and/or radiofrequency treatments to get the best results.  Please see an expert for evaluation.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 203 reviews

Microneedling Is An Effective Means For Blending The Surface Tone & Texture Of Treated Scars

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The direct answer to your question can be found in the February, 2016 issue of Dermatologic Surgery, one of aesthetic medicine's premier, peer-removed journals.  Following a study to compare fraxel erbium laser with simple microneedling for the treatment of acne scars, the authors concluded that the results were comparable, but that: " Microneedling is well tolerated, with fewer side effects and lower down time."  Treatment is also typically considerably less expensive.

In another issue of Dermatologic Surgery, in an article specifically devoted to the use of medical microneedling in skin of color, the authors, in referring to its use for acne scars, concluded, "...in darker skin types, microneedling can be a useful therapeutic option." 

That having been said, the photo also shows evidence of some atrophic box scars and pit scars. Atrophic scars can be treated with subcision to elevate them and pit (ice pick) scars can respond well to the TCA CROSS Technique. In that same article sited above, the authors also noted the value of subcision in skin of color.

Make sure to consult with a board certified aesthetic physician with experience and expertise in treating acne scars in persons of color. 


Acne Scars

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It's hard to say for sure from the single picture.  Our office provides the full range of treatments for acne scars including microneedling, laser, fillers, and TCA CROSS.  I would recommend evaluation in person to determine the best approach for you.  
Dr. Ort

Microneedling vs laser? ENGLEWOOD Cliffs NJ

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Your question is very timely. A recent study stated that for superficial atrophic scarring, both ablative and non-ablative Laser and standard micro needling produced equivalent effects. When I look at your pictures, I do see some deeper atrophic scars. There are also some acne pits and ice picks. My suggestion would be to undergo subcision to lift the deeper scars and combine it with either aggressive micro-needling or non-ablative or ablative lasers. Since you have darker skin, I would avoid TCA cross for the ice pick scars. You may need to be pre and post treated with a bleaching cream to prevent post inflammatory hyperpigmentation. Look for an acne scar expert. Ask to see photos. Good luck.

Jeffrey Rapaport, MD
Englewood Dermatologic Surgeon
4.7 out of 5 stars 43 reviews

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