Subcision with Cross or CO2? (Photo)

Question

Hello, I've spoken to 2 skin professionals who recommended 2 different things. 1 recommend 2-3 sessions of Subcision with Cross and microneedling. The other thought that that option was not a good idea and suggested I'd do 2-3 sessions of CO2 with filler instead. Pictures are attached. Please guide me in the right direction. Thank you in advance, docs!

Nelson Lee Novick, MD · Answer

I have been performing subcisions since 1994 for treating all kinds of indented (depressed, atrophic, sunken) scars from all causes, whether post-surgery, post-trauma, or boxcar and rolling scars post-acne. Subcision is a simple, inexpensive and tried and true technique for elevating and smoothing wider-based sunken scars, such as chickenpox scars and the boxcar and rolling scars that follow acne, as in your case. The results of subcision are long-lasting to permanent. Ice pick scars and dilated pores are best treated by TCA CROSS, a technique that I have been employing for the past twenty-two years. Here, too, the results tend to be long-term or lifelong. And finally, for also about twenty-two years, I have been employing professional microneedling to better blend the color and texture of the above-treated areas  with the surrounding normal skin. Your photos suggest some generalized facial atrophy and slight sinking, so a Field Subcision should be discussed with your physician. (Just fyi: There is no hard science to prove that radiofrequency microneedling is any more effective than standard, simple microneedling-although it certainly more expensive and often more uncomfortable to undergo).  All of the foregoing procedures can be performed during the same treatment session if deemed necessary if logistics dictate. So no worries there. Be cautious when evaluating claims for this or that bells and whistles laser or energy-based devices as the purported benefits of these tend to be backed far more by device manufacturer supported marketing hype than hard science. Make sure that you are consulting with a board certified aesthetic physician with extensive acne scar treatment experience before agreeing to proceed, and for more information on any of the above, check out the archives or RealSelf.com. Best of luck.

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

Jason Emer, MD · Answer

Fraxel and/or CO2 are best for resurfacing, but Erbium is a good alternative. I always combine lasers with microneedling/PRP for more robust outcomes. For skin tightening, I recommend a combination of Ultherapy with RF treatments and Sculptra for skin tightening. I recommend getting a formal evaluation with a cosmetic dermatologist. Best, Dr. Emer

Jeff Rapaport, MD · Answer

In  my opinion, you have tethered saucer-shaped scars, box cars and pits. Both treatment plans recognize the need to lift the scars. I prefer subcision and PRP, microneedle radio frequency and TCA cross. If needed, this can be followed by  ablative low density laser and fillers.Jeff Rapaport MD FAADRealself Verified All-star

Steven F. Weiner, MD · Answer

I see mostly rolling scars and boxcar scars. I would treat with TCA Cross and subcision. I'd also add RFM, the Genius, at the same time. I don't think filler is needed initially but may be needed down the road if you can't get the elevation needed with these treatments. CO2 I would also hold off on  because your skin is at risk for PIH. Consider 3-4 treatments initially.

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Answers (6)

Answer: Scar types and treatment protocol? Englewood Cliffs New Jersey

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Answer: Treating acne scarring with subcision and TCA Cross? Steven F. Weiner, MD

Answer: Treating acne scarring with subcision and TCA Cross? Steven F. Weiner, MD

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