Subcision w/ Restylane Silk? (Photo)

Question

I have had one co2 fraxel and one erbium laser. I would like to try subcision with filler and PRP. Am I a good candidate for this?

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 HIDEF 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 been 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 laser 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.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. 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

Nelson Lee Novick, MD · Answer

Really sorry that you apparently have not been satisfied with your prior fraxel and erbium laser treatments for your acne scars. But, unfortunately, I cannot say that I am surprised.. It is another example of exactly why I have been cautioning my readers for years to exercise a hefty dose of "buyer beware" when considering treatment with any of the relatively expensive "bells and whistles" energy-based devices, including fraxel lasers and RF machines. These supposedly "next big thing" devices are backed far more by intensive marketing hype than any hard science. Sorry. Non-faddish acne scar treatments that have stood the test of decades of use for safety and efficacy in all skin types include Field Subcision for generalized cheek and temple acne scar-related atrophy; individual subcisions for elevating and smoothing boxcar and rolling scars; and professionally performed conventional microneedling for addressing any residual skin texture and color irregularities in the treated areas. Make sure to consult an experienced, board certified cosmetic dermatologist. Best of luck.

Subcision w/ Restylane Silk? (Photo)

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Subcision w/ Restylane Silk? (Photo)

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