I have icepick scars, is Bellafill the best treatment option?

Question

Hi I am 23 year have some terrible scars when I use to use my nails to pop my zits and now I am left with few scars deep scars box scars and icepick scars I just need a permanent solution thank you

Jason Emer, MD · Answer

Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. - Subcision for depressed, tethered scars. - Vascular lasers like Yellow laser, Aerolase, excel V, or IPL for redness or thick acne scars. - Lasers such as Fraxel, Erbium, CO2 or fractional radiofrequency (Venus Viva, Skinfinity, Intensif microneedling RF) for textural issues and superficial scarring. - TCA CROSS and punch excision for deep ice pick scars and narrow box car scars. 
All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer.

Raffy Karamanoukian, MD, FACS · Answer

Bellafill and Artefill are known to cause granulomas. Although used for soft tissue augmentation, they can, and are known to cause permanent nodules and swelling. This is not the case for everyone. 
My office specializes in the removal of Bellafill and Artefill injections, in addition to silicone biopolymers, from the face and body. Initially, treatments are non-surgical with corticosteroids and immune modulators. If unable to be corrected, we can also perform surgery in some cases. 
Lastly, our office is conducting ongoing studies of plasma-assisted corticosteroid application, which allows for diffusion of the treatment medication in superficial tissue without causing atrophy. 
Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Steven F. Weiner, MD · Answer

I don't believe you have ice pick scars. Bellafill is not the answer for ice pick scars, TCA Cross is. It looks like you have depressed scar that require subcision, filler such as Bellafill, and Genius. Multiple treatments are needed. These are more saucer type scars, I believe.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Hard to say with the photos provided. If you have true ice picks, TCA or Phenol paint or Cross would be the treatment of choice. Bellafill best for atrophic scars. The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. 
Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. 
Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. 
The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. 
My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. 
All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.

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