Consider multiple options for acne scars
There is no one great treatment for acne scars. Each has its advantages and disadvantages.
I usually recommend the combination of several different treatments
Fat grafting may help by several methods. Just placing the fat may be a subcision method of undermining the depressed scars. It will be more helpful for saucer scars than icepick scars. The fat may give a "stem cell" like effect with improvement of the complexion.
I usually use Juvederm as I can place it more superficially than fat.
We use the microneedling as well. It creates more collagen and plumps the area. It is a series of treatments, but recovery is minimal and costs are low.
We sometimes use a non invasive laser such as Cool Touch or Thermage for tightening.
We do subcision of areas.
We also will excise small icepick scars.
We rarely recommend invasive lasers, as the results are limited for such a long recovery and risk.
Fat Injections for Acne Scars
There are different types of acne scars and many of them are very difficult to improve. Generally saucer-shaped or box acne scars respond best to filler injections as it needs a widely-based acne scar to allow it to be pushed outward. I would test the 'underneath' approach by having a synthetic filler placed first to test the concept. If successful you may then undergo fat injections possibly combined with laser resurfacing on the outside at the same time.
The Treatment of Facial Acne Scarring
Acne scars can be very difficult to treat, especially when more severe. A multimodality approach is usually the best plan, and can include direct excision of the scar, filler placement (with or without subcision), and laser resurfacing. The use of fillers works well for scars that are more superficial and softer; if the scar can be improved with manual stretching of the skin then it will often respond favorably to filler. Scars that are deeper, more fibrotic and tethered to deeper planes are much more difficult to fill; these may be better treated with excision. The use of fractionated laser resurfacing, such as the Fraxel laser, is often of great benefit and has added to our ability to improve acne scarring. In fact, once the more severe scars are addressed surgically, I would often consider fractionated laser resurfacing the “go to” treatment.
Best wishes, Ken Dembny
Fat Transfer for Depressed Acne Scars? Is This Possible and How Are the Results of the Procedure in the Facial Area?
Acne scars will not see 100% improvement with anything and will need a variety of measures including possibly laser resurfacing, filler or fat placement, and direct excision of the deeper ice pick scars. A physical exam is always necessary to appreciate some of the subtlety in acne scarring and determine which modalities will have a greater likelihood for success. Kenneth Hughes, MD Los Angeles, CA
Fat grafting does not work well for acne scars.
Acne scars is very problematic because the skin is anchored to the deeper connective tissue by scar. Successful treatment is only occasional in involves release of the scar with intervening placement of material. This doesn't really work well with any filler including fat.