No improvement at all after TEN sessions (Photo)

Question

Asian Female age 37, deep acne scars , hyperpigmentation around mouth. NO affect after 10 painful, time consuming Below sessions 1 PRP 3 subcisions 1 PRP + Vampire 2 picoways 1 sylfirm 2 co2+fractional It’s not curable? Any permenant fast solution? Thanks

Jeff Rapaport, MD · Answer

The primary goal with your scars is to lift the bases and release the attachments. I would recommend an extensive Subscision with Cannula to subscise your entire cheek. This would be combined with microneedle radiofrequency, Intralesional PRP,  TCA cross and aggressive CO2 laser in one session. Find a scar expert. Good luck.
Jeff Rapaport MD FAAD 
Realself Hall of Fame 
Castle Connolly Top Doctor

Anna Chacon, MD, FAAD · Answer

I can understand how frustrating and discouraging this must feel, especially after going through 10 treatments that were painful, time-consuming, and likely expensive. The good news is that deep acne scarring and hyperpigmentation are not necessarily untreatable, but there is no single procedure that can permanently and quickly eliminate every type of scar.

You’ve already tried several treatments, including PRP, subcision, PicoWay, Sylfirm, and fractional CO₂ laser. These treatments work in different ways, and the results depend heavily on the type of scarring, its depth, whether the scars are tethered to deeper tissue, and how your skin responds to inflammation.

If you’ve seen absolutely no improvement, I would reassess the diagnosis and treatment plan before proceeding with more sessions. Rolling scars, ice-pick scars, and boxcar scars often require different approaches. Some respond better to subcision, while others may benefit from carefully selected resurfacing procedures or focal treatments. In some cases, a combination approach is necessary, and improvement may be gradual rather than dramatic after each session.

The hyperpigmentation around your mouth is a separate concern. In Asian skin tones, inflammation from aggressive procedures can sometimes trigger or worsen post-inflammatory hyperpigmentation. Repeatedly increasing treatment intensity may therefore make pigmentation more persistent rather than improve it. Daily broad-spectrum SPF 30–50 sunscreen and a dermatologist-guided pigment regimen may be important while your skin recovers.

As for a permanent, fast solution, I want to set realistic expectations: there is currently no reliable treatment that guarantees complete, permanent removal of deep acne scars in a short time. Procedures can soften their appearance, improve texture, and make scars less noticeable, but some residual scarring may remain. Additional aggressive treatments are not automatically better, particularly if your skin has not responded to the previous ones.

My recommendation would be to pause further procedures until your skin has fully recovered and obtain an independent assessment from a board-certified dermatologist experienced in acne-scar revision, ideally one who can distinguish the specific scar types and evaluate why the previous treatments have not helped. Reviewing standardized before-and-after photographs, the settings used, and the intervals between treatments may help identify whether the approach needs to change.

You have not necessarily reached the end of your treatment options. However, after 10 sessions without noticeable improvement, the next step should be a more targeted strategy—not simply another procedure. The goal is meaningful improvement while protecting your skin from additional inflammation and pigmentation.

Raffy Karamanoukian, MD, FACS - Account Suspended · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

No improvement at all after TEN sessions (Photo)

Answers (3)

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