37 year old female with rolling acne scars. Should I try dermapen, lasers, or facelift? (Photo)

Had cystic acne as a teen and was on a myriad of medicines (accurate twice etc). At age 23, co2 laser resurfacing. Now after two children and aging, my skin is starting to sag and elasticity is wearing. Scars are showing more deeply. My normal surgeon (performed mainly 5 lipo surgeries on me and a temporary lift), suggests a mini facelift to smooth out the scarring. Is there anything that will work better? Seems I will just have this complaint again in another 10+ years when my skin ages again.

Doctor Answers 4

Acne Scarring -- Requires a Combination of Fractional Laser Resurfacing, Fillers Like Bellafill, Subcision and Eclipse Micropen

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this type of scarring needs a combination of lasers, fillers, subcision, surgery.  I suggest you see an expert.  Best, Dr. Emer.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 207 reviews

Rolling acne scars

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Dear JuneSorry that you have suffered so much with this through your life. Your surgeon is partly correct that a limited mini high facelift, aka cheek lift will help because the acne scars will be released from below and the skin tightened. I have had such patients.However, I do not think that it is your best option. The scars can be released via subcision without undergoing the minilift. Moreover, the contour deficiency in the "holes" of the scar are best filled with refined auto fat stem cells. There has been great success in recent times with the processing of a patients on fat for reinjection into their own body.I have seen many like you and encourage you to consider subcision with autofat. ThanksGreat question

Richard Sadove, MD
Gainesville Plastic Surgeon
4.9 out of 5 stars 32 reviews

Facelift for acne scars?

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A facelift is not the way to correct acne scars. If you have volume loss, scars will look worse and volume replacement with fillers will help. I would treat with Infini for 2-3 sessions me then fill deeper scars with Bellfill as well as correcting volume loss with it. Please get another opinion. 

Steven F. Weiner, MD
Panama City Facial Plastic Surgeon
4.9 out of 5 stars 75 reviews


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Dear alyjune,

Thank you for your question. 

Acne scars are common, but with advancement in technology, you do not have to live with it.

Acne scars are the result of the breakdown of collagen and elastin in your dermis. They frequently occur at sites which were acne prone in the past, namely your temples, cheeks etc.

Acne scars are 3 dimensional, hence submitting a photo will not do justice to your scar. It requires real time examination (touch and animation), combined with lighting from various angles. That is why you may notice your scars differently in the bathroom mirror and in the dressing table mirror.

Dr Daniel Chang’s 3 STEP ACNE SCAR Treatment Formula: 

1- Control acne

2- Treatment – Fractional laser + skinboosters ( to promote collagen growth)

3- Maintainence with lasers ( to optimise collagen stimulation)

STEP 1: CONTROL YOUR ACNE. (Refer to this page on acne for more information)

Achieving good control of your acne is the important principle towards helping your acne prone skin. This prevents new scars from forming, which is a big step forward. Dont be too worried about your existing acne scars. Focus on prevention first.

STEP 2: Treatment based on scar type. Below are the 4 main types.of atrophic scars.

Ice pick scars =>    can be treated with TCA CROSS, Fractional and Microneedling

Rolling and box scars scars => are best treated with a combination of  RF Microneedling, PRP, fractional lasers and subcision

Hypertrophic scars can be treated with

  •  Microbotox
  • Intralesional steroid

Atrophic scars -> A combination approach is what I would recommend to improve the appearance of such scars.

  • Laser Resurfacing +/- RF microneedling 
  • Subcision
  • Dermal fillers – Skinboosters – Please refer to my Page on Skinboosters 
  • Intralesional saline – ( Latest evidence from Journal of Dermatology Sept 2016)

Fractional C02 used to be the industry gold standard for treatment of acne scars. Current studies point towards combination therapy, as I have outlined above. In addition, As collagen takes 3 months to grow, multicentre studies show one would require at least 4 sessions to see results. 1 session is unfortunately not enough.

New technology includes air dissection. Being a new treatment, I do not know of any randomised controlled trials regarding its safety and efficacy at present. Most studies are anecdotal. So time will tell.

You have rolling atrophic scars, so the combination approach above would help you.

I hope you find this helpful.

Daniel Chang, MBBS
Singapore Physician

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.