Would subcision, or a series of chemical peels or microneedling treatments help? (Photos)

An in-person examination that would not only allow close-up inspection but direct palpation and manipulation of the skin would be extremely helpful. From what can be seen in the photos, there appears to be quite a bit of residual superficial scarring, which may be made more prominent by underlying acne-related atrophy throughout the cheek. If so, then a Field Subcision would be in order. The photos also suggest an abundance of what appear to be dilated pores and ice pick scars. If so, then TCA CROSS would be a very reasonable approach. Both procedures are relatively inexpensive and each has a several decades' long track record for efficacy and safety in all skin types. You would be wise to consult with an experienced, board certified cosmetic dermatologist. Best of luck. .

Since you have had CO2 laser 3 times I would switch things up and do a series of microneedling with PRP or exosomes. Your improvement so far has been very good and I would expect more benefit from the microneedling. Good luck!

Hello and thank you for your question! We prefer standard Microneedling (non-RF) at our practice for improvement in Acne Scarring. We tend to avoid RF Microneedling on the face due to risk of facial fat loss. Subcision would work well for deeper acne scarring as well, but it is obviously a more invasive option compared to microneedling, chemical peels, or lasers. As always, a consultation at a Plastic Surgeon's office in-person would allow us to provide the best recommendations for your issues. Hope this helps!

Acne scarring is never something we cure but we can improve, a series of co2 lasers is a nice way to make major change. If I am still dissatisfied I will add dermabrasion , not microdermabrasion, and or radiofrequency microneedling to the totality of the facial skin. Subcision is helpful for a limited number of deep pock marks but I feel that something needs to be injected to avoid it sinking back in, either filler or fat, alternatively prp.

Hello Lucy36. We have been using a relatively new modality to treat scars and aging called Ellacor. We have gotten some fabulous results. I would suggest a consultation with a plastic and reconstructive surgeon in your area that offers this to obtain to see if this might be an option for you.

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

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.

In all modalities of skin surface treatment ( chemical peeling, laser or dermabrasion ) where the most superficial layers of scarred pits, a noticeable improvement should expected. If it will be combined with subscision ( where release of tiny fibrous bands pulling the undersurface of the skin will add to the result. We need to keep the following if doing these procedures:Minimum of three months of cold environment after treatment to avoid pigmentation problemsGiving enough time for skin healing 3-6 monthsNot repeating these procedures too much to avoid generalized thinning of the skin.

Based on your description of previous treatments, it's possible that additional procedures could further improve the appearance of your acne scars.

Subcision
How it works: Subcision involves breaking up scar tissue beneath the skin's surface to help reduce the appearance of indented scars.  
Potential benefits: It can be effective for deep, boxcar scars.
Considerations: It may require multiple sessions and can cause some discomfort or bruising.  
Chemical Peels
How they work: Chemical peels exfoliate the skin's surface to encourage new cell growth.  
Potential benefits: Can help improve the appearance of superficial scars and discoloration.  
Considerations: Deeper peels may require more downtime and carry a higher risk of complications.  
Microneedling
How it works: Microneedling involves creating tiny punctures in the skin to stimulate collagen production.  
Potential benefits: Can be effective for a variety of scar types, including rolling and boxcar scars.  
Considerations: May require multiple sessions and can cause temporary redness or discomfort.  
A combination of these treatments might be beneficial in your case. For instance, subcision could be used to address deeper scars, while chemical peels or microneedling could help with surface irregularities and discoloration.

It's essential to discuss your options with a doctor or dermatologist to determine the best approach based on your specific skin condition and goals. They can also provide guidance on potential risks, benefits, and expected outcomes.

Hi there! 60% is a substantial improvement. Your photos look quite nice and many don't often get that level of response. You could certainly try any of the 3 you mentioned. Subcision is best for deeper, tethered scars. Microneedling and chemical peels may be the way to go. Hope this helps.