Which type of laser treatment would deliver best results for minimizing the appearance of 15 year old deep acne scars? (photos)

Question

Hi, I have acne scar for 15 years. I had done with subcision 3 times, eMatrix 1 time and Deka laser around 5 times. But the result is not improved as expect. I have heard that the result of Fractora and Infini are GREAT for deep acne scar. Please suggest which laser or treatment that would be suitable for to reduce acne scar

Nelson Lee Novick, MD · Answer

While there are some broad-based boxcar scars, at least from the photos provided, there seems to be an overwhelming predominance of ice pick scars and very narrow-based boxcar scars. Subcision, which I have been performing since 1995, is NOT indicated for the treatment of ice pick scars and so there is no suprise that this didn't work. There is also little surprise that the relatively expensive bells and whistles fraxel lasers and RF devices didn't work either, since the hard science to support the use of these lags woefully behind the heavy marketing to promote them. A Field Subcision (as opposed to individual subcisions) would likely help to diminish the appearance of the overlying ice pick scars, dilated pores and narrow-based boxcar scars. This can then be followed by TCA CROSS, another relatively inexpensive and time honored approach for treating ice pick scars, narrow-based boxcar scars and dilated pores, which I have been using with gratifying results for the past twenty-three years. You would probably do better (and save a whole lot of money, time and frustration) to seek consultation with an experienced, board certified cosmetic dermatologist than jumping from one expensive, faddish, here-today-gone-tomorrow light or energy-based device. Hope this helps and best of luck.

Ali Sajjadian, MD, FACS · Answer

Hi,
Fractora is a great choice for deep depressed Acne scars. It heats deep skin by the radiofrequency waves that are coming from the tips of Fractora fine needles. So the scar bands will be loosened and then the new collagens will come and replace these scar bands. You need at least 3 sessions of Fractora .

Best regards,
Dr Ali Sajjadian

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

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

CO2 is the best laser for scars, but Erbium and Halo with Profractional are great alternatives. It may take a series of treatments to see improvements and to maintain. Keep in mind that a tailored combination approach will give you the most improvement with acne scars. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​

Which type of laser treatment would deliver best results for minimizing the appearance of 15 year old deep acne scars? (photos)

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