Shallow acne scars. Which treatment would be best? If I go for CO2, will my skin tone totally change? (Photo)

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

Nice photos, they are very helpful in allowing us to see the action.  Acne scars can be very distressing and effect how we feel in the presence of others.  I would recommend that you look into either laser such as Less downtime with great results. Non ablative treatments with Fraxel Dual or more invasive with more significant results C02 like Deep Fx/Active Fx. Some less invasive non-laser options include needle subcision, microneedling with PRP or Bellafill injectable filler.  The best fit is one that fits in the amount of time you can commit to the treatment and your price range.  However, the most important thing to reduce scarring is prevention of further acne with a good skin care regimen.  You may want to consider a combination approach, for the scar redness, which can catch the eye,  with a vascular lasers such as pulse dyed laser.  I recommend that you see a Board Certified Dermatologist or Plastic surgeon with expertise in these techniques.

The good news with acne scars is there are a lot of different things that can be done.  The bad news is that means no single method is best.  CO2 in your skin type has to be done carefully, but it does not have to permanently alter your skin tone, but there will be a period of redness (for months) and then the skin can become lighter.  Overall though, it is a good method for smoothing out scars like those you have.  There are other good options like microneedling, PRP and injectibles that don't have the downsides of the laser but have to be done a few times or even more in order to see enough improvement.  

There are limitations treating skin of Asian descent with the C02 Laser.  Best to use hydroquinone 4% topically for 3-4 weeks prior to treatment to reduce the risk of hyper pigmentation. Fortunately, your acne scars appear to be good in colour, which is half the battle in treating acne scars.  As for the depressed nature of the scars and general volume loss, Bellafill injections would provide you will permanent smoothing of the scar by lifting the depression. Bellafill is a stimulatory filler that can regenerate your skin and improve the overall appearance.   Combination treatment often delivers best results. 

Hello Bina1974,When it comes to acne scars there are many treatments.  A lot of the treatment recommednations depend on how the scars actually look.  For example, the pinpoint ice pick scars are best addressed with either surgery or in some cases a particular chemical peel just to the scar.  With diffuse acne scarring creating skin irregularities, some form of resurfacing is ideal.  The true gold standard is going to be dermabrasion.  This works by trying to lower the surrounding skin.  However, it has more downtime than many of the other treatment modalities.  For this reason, a fractionated CO2 laser may be helpful as well. As you indicated you have an Asian skin tone, you do need to be more careful with a CO2 laser, and test spots may be needed.I'd recommend you consult with a facial plastic surgeon to go over your options and learn what is best for you.I hope this helps and good luck.  

Sure, one can use low density CO2 with safety, but I would also combine this with microneedling RF with insulated needles and subcision. You will need 2-4 sessions for 50% improvement. This is a realistic outcome. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help.

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, PRP 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 surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal 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. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best,

Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.