34 year old female with severe scarring and cystic acne. What can I do?

I've had acne since my teens and it hasn't gone away and am worried it never will. I keep getting them in the same place over and over and my skin has no chance to heal properly. The cystic acne will stay under my skin for weeks and sometimes months but only to come up again and they hurt like crazy. I mainly get them between my cheeks and jaw bone and on my chin. I'm fair skinned and my scars are purple/brown. What can I do?

Doctor Answers 7

Acne scar surgery in Los Angeles

Our office specializes in acne scar revision. We use a combination protocol that includes sublation, ablative laser, non ablative laser, chemical peels, topical therapy, and scar surgery. 

Best, 
Dr. Karamanoukian 
Los Angeles


Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Acne Scar Options

A variety of treatment approaches are available for acne scarring and most often more than one approach is required for the best result in my experience. Picking the best one or combination of treatments depend on the type and extent of scarring, whether the acne is active, color, and size and your skin type. Treatments include undermining ("subcission") depressed scars, excision and closure for large depressed scars, various lasers (CO2, Erbium, Yag, Alexandrite), dermabrasion (not microdermabrasion), Needling (e.g. Dermaroller), RadioFrequency ("RF" devices), and Chemical Peels. For those of darker complexion use of fractionated lasers, RF, subcision or needling tend not to alter your skin color. Many of these treatments are not recommende in the first year or more following Accutane treatment. More than one treatment or a combination of treatments are often necessary for best results. It is most important to see a plastic surgeon or other physician well versed in all of these methodologies and to guide you regarding realistic expectations with each of these options. He/she will guide you to the best approach tailored to your needs.

Treating Adult Acne

Thanks for your question and my first suggestion is that you seek out a board certified dermatologist to help treat and control your acne. We have great medical treatment for cystic acne and you need to see what will work with best for you to get the acne under control. Once the acne is under control, there are many wonderful technologies to get the scarring better, which include the non-ablative fractional lasers, the ablative fractional lasers, the sublative RF devices, and the new microneedling RF devices. A proper consultation is needed to determine the best course for you.

Michael Gold, MD
Nashville Dermatologic Surgeon
3.9 out of 5 stars 17 reviews

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Try medication and then consider PDT

It is difficult to give you a fair assessment without first knowing what you have tried. I would suggest you consider an initial regimen of antibiotics and topical creams. Accutane might be an option for you as well. You should also consider several Levulan/Light treatments or PDTs to help decrease the acne. The PDT will also help with some of the scarring you mention. Seeing an esthetician several times a month sho0uld also be considered. Acne can be a trial and error skin disorder. What works for one person may not work for another. What worked for someone a year ago may suddenly stop working and require modification.

Bernard Raskin, MD
Valencia Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

First get acne under control before treating scars

Levulan is a great option for controlling cystic acne if you don't want to use Accutane. 3 treatments are needed. I let incubate for over an hour and activate with a laser and Blu U. Retin A, with aggressive topical therapy is also needed. Sometimes antibiotics are also needed. When acne controlled, the Infini, a deep RF with microneedles, is the best I've seen for acne scars. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.6 out of 5 stars 27 reviews

Severe Scarring Nodulocystic Acne In An Adult Requires Aggressive Topical, Oral Therapy & In-Office Treatments

First, let me say how sorry I am that you are suffering with this problem. Acne, as you know only too well, is not solely a disease of teenagers. I surprisingly significant number of adults, particularly women, ranging from their twenties to even the early fifties continue to suffer from it. It is characteristic that when acne persists into these later ages, it involves the lower face, jawline and under the chin regions. Since acne does affect such a proportion of the adult population, we prefer to use the term acne vulgaris (meaning common acne) as opposed to "teenage acne," so as not to insult those adults suffering with this physically and psychologically troubling condition. 

While many would jump to the use of isotretinoin (Roaccutane) for treating severe acne, owing to its many short and long-term side effects, I prefer to follow the guidelines for its use, which reserve it expressly for those individuals who have failed an appropriately long course of the most intensive COMBINED topical, oral (which includes antibiotics, specific supplements, hormonal therapies) and in-office treatments available. (Unfortunately, I have typically found that most individuals have not been treated with or for a long enough time with the appropriate intensive combination therapies.) Thankfully, I have personally not needed to use oral isotretinoin for over fifteen years. 

Once the acne is under control and there are no further breakouts, that would be the time to be evaluated for the treatment of any post-inlammatory skin discoloration and acne scars that have resulted. Be sure to seek consultation with a board certified dermatologist experienced in the management of severe, scarring nodulocystic acne and be wary of anyone who simply wishes to prescribe isotretinoin. 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.8 out of 5 stars 23 reviews

Cystic Acne and treatment for scars

Cystic acne is an extremely painful conduction and if you are suffering so much I recommend Accutane therapy. After the course is done you can have the scars treated with a combination of V-beam for the purple scars or EMatrix or Fraxel for the deeper scars. Please consult a board dermatologist with experience in these lasers for acne scars to best treat you. 

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.