Not able to decide between subcision & Microneedling RF for atrophic acne scars (Photos)

Question

I have atrophic acne scars of all 3 types (Box scars, rolling scars and ice pick scars). I met 2 dermatologists near me and they both suggested 2 different treatments. One doctor suggested Microneedling RF while other doctor suggested subscision and filler process for rolling scars and dermapen for box scars. Now I am a bit confused on which doctors advice to follow. Any suggestions are welcome.

Nelson Lee Novick, MD · Answer

I have been performing subcisions for boxcar/rolling scars since 1995;  TCA CROSS for ice pick scars for over twenty-three years and professionally performing microneedling for superficial skin texture and color irregularities for about as long as TCA CROSS. Bottom line: I have  very extensive experience in all of these modalities and at least from the photos provided the predominent issues appeaar to be extensive acne-atrophy-related cheek atrophy (sunken cheeks that make the overlying scars even more prominent), as well as numerous ice pick scars and dilated pores. So, first a Field Subcision for the cheeks would help to reinflate the cheeks and hence also diminish the prominence of the overlying scars. One wouldn't dream of building a house without putting in a solid foundation, so Field Subcision would essentially be putting in the necessary foundation. Once this is done, then TCA CROSS, which is safe for use in Asian skin (because it was developed in South Korea for Asian women suffering from ice pick scars) can be used to treat the many ice pick scars and dilated pores present. Once this is done, any remaining boxcar/rolling scars can be subcised, if still desired. Then, if still desired, professionally performed microneedling needling may be used as a final "polishing" step to blend the aforementioned treated areas better with the surrounding normal skin; it is not a particularly good modality as a primary monotherapy for scars.  I hope this helps. You would be wise to make sure that you are consulting with  board certified cosmetic dermatologists. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

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

Not able to decide between subcision & Microneedling RF for atrophic acne scars (Photos)

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Not able to decide between subcision & Microneedling RF for atrophic acne scars (Photos)

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Everything you need to know about Subcision

Our mission is to create a world where every investment in modern beauty is Worth It.