I have deep cysts/acne scar, help (Photo)

Question

I am writing to seek advices, I have deep hollow scars caused by acne cysts on both cheeks, and I have undergone 4 sessions of fractional CO2 laser treatment with no noticeable results. What recommendations do you have? The doctors keep recommending CO2 laser and microneedling, but I am afraid they won't do anything and won't address the hollowness. Thank you

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 acne 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

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Shah Facial Plastics. This is a great question. Based on you history and images, I recommend treating the scars with a combination of injections with Bellafill and resurfacing with Morpheus8. I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Nelson Lee Novick, MD · Answer

I'm sorry you are suffering with this, but I am not at all surprised by the failure of the fraxel treatments . I have been cautioning my regular followers for years that these kind of expensive energy-based gizmos (as well as the RF gizmos) are backed far more my social media buzz and marketing hype than hard science, as your frustration and lack of success highlight once again. Ablative CO2 laser treatment, like dermabrasion, is a very aggressive, almost surgical approach, that engenders a prolonged post-treatment downtime and possesses the risk of scarring, dyspigmentation, and a shiny unnatural is appearance to the skin when fully healed. Microneedling is more like a final "polishing" step and is best reserved for blending any residual texture and color abnormalities, rather than a primary treatment for deep acne scars. Instead, to elevate and smooth the scars, you would be wise to consult with a board certified cosmetic dermatologist acne scar specialist trained in subcision--both in Field Subcisions, which would address the generalized facial atrophy seen in the photos & individual subcisions. to improve those scars that did not achieve sufficient improvement from the Field Subcision. Hope this helps and best of luick.

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