Hypertrophic acne scarring - would love to know if any procedures would work (photo)

Question

I have collected these scars throughout my life. The center chin scars are about 20 years old from a cystic acne breakout. The rest I accumulated while on Accutane. I tend to scar hypertrophic, with my body producing excess collagen and raised scars. I didn't use silicone or anything that would have helped. I did not know my options. I have saved money but want to invest wisely into treatments that will actually work. Tried 2 fraxel treatments and felt it made scars worse. Please help! :)

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best,
Dr. Raffy Karamanoukian
Realself100 Surgeon

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Especially from the photo of your chin, there appear to be what has come to be called papular acne scars, which can be thought of as a kind of small mounds of hypertrophic scas. They usually appear on the nose and chin, but can much less commonly be on any area of the rest of the face.  
I have found three treatments to yield gratifying improvement for treating this problem, intralesional anti-inflammatory injections, Scalpel Sculpting, and low intensity electrocautery, and I typically perform a test of each of these three methods on any new patient papular acne scars to determine which method is most suitable.  I have found that most often low intensity electrocautery proves the most suitable approach for the vast majority of individuals with this problem. 
Unfortunately, I am not surprised at your lack of success with the fraxel lasers. I have been cautioning my regular followers for many years that the hard science to back up the use of fraxel and other expensive, light and energy-based gizmos lags well behind the heavy marketing hype and social media buzz to hawk them. Sorry.
You would be wise to consult with an experienced, board certified cosmetic dermatology acne scar treatment specialist. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

Dealing with hypertrophic acne scars can be challenging, especially when previous treatments haven't yielded the desired results. Here are some options you might consider for managing hypertrophic scars:

Silicone Products:
Silicone Gel or Sheets: Although you haven't used these before, they are often recommended for reducing the size and redness of hypertrophic scars by hydrating and protecting the scar tissue.

Steroid Injections:
Corticosteroid Injections: These can be effective in flattening raised scars by reducing inflammation and collagen production.

Laser Therapy:
Pulsed Dye Laser (PDL): This laser treatment targets blood vessels in the scar tissue, which can help reduce redness and flatten the scars.
CO2 Laser Resurfacing: Although you had a negative experience with Fraxel, CO2 lasers might offer a different approach by removing layers of skin and promoting regeneration.

Microneedling:
This procedure can sometimes help by creating micro-injuries that stimulate collagen remodeling, although it might be more effective for atrophic rather than hypertrophic scars.

Cryotherapy:
This involves freezing the scar tissue, which can help flatten hypertrophic scars, often used in combination with other treatments like steroid injections.

Surgery:
Scar Revision Surgery: In severe cases, surgical removal of the scar tissue followed by careful wound management might be an option, though it carries a risk of new scar formation.

Considerations:
Consultation: It's crucial to work with a dermatologist or plastic surgeon who specializes in scar treatment to tailor a plan specific to your scar type and skin.
Patch Testing: Given your previous experience with Fraxel, you might want to consider patch testing new treatments on a small area to see how your skin responds.

Investing in a thorough consultation with a specialist will help ensure that you choose the most effective and appropriate treatment for your hypertrophic scars.

Hypertrophic acne scarring - would love to know if any procedures would work (photo)

Answers (3)

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