Will Microneedling or RF Microneedling improve these acne scars and large pores? (Photos)

The subject line outlines a proven approach for treating all kinds of acne scars. TCA CROSS was developed over twenty years ago for the treatment of ice pick scars and dilated pores. Used for larger boxcar scars, it can sometimes actually widen them. Subcision was developed well over a quarter of century ago for elevating and smoothing boxcar and rolling scars. Both TCA CROSS and subcision can be used safely and effectively in all skin types, including skin of color. Professionally performed microneedling, which also has well over a two decade history of safe and effective use, is best reserved for improving any residual superficial textural and color irregularities that persist following the use of the aforementioned treatments. It is not a particularly effective treatment for the first line treatment of deep ice pick or boxcar/rolling scars, except for perhaps the most shallow versions of these. Other, relatively expensive and heavily promoted treatments, like fraxel lasers and RF microneedling, to date are much more supported by device manufacturer marketing hype than any hard science. So, when it comes to these, a healthy dose of "buyer beware" is in order. Make sure to consult with a board certified cosmetic dermatologist and acne scar specialist. Best of luck.

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.
Best,
Dr. Karamanoukian
Realself100 Surgeon

The ideal treatment for acne scars will depend on YOUR pattern of scarring. Do not approach scar revision with method in mind, but rather the opposite. In you case, the scars on the left side are box car and shallow, simple TCA or phenol will do. The ones on the lower face may require subcision, hard to tell with the photos. RFM is not indicated as a primary procedure, but it can be useful for rolling scars. Above all things, treat your acne as the reduction of inflammation can compound your results.

Treatment methods are employed to best address your scar pattern. 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.

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 consultation with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis.

All the best,
Dr Davin S. Lim
Dermatologist. Brisbane
Australia.