Would I benefit from more subcision and fully ablative laser? (photos)

Question

I have had 3 mini subcisions done over few years, 3TCA cross, 3RF microneedling and PRP, and lastly fully ablative CO2 for my scar revision. It's been 2 years since my laser treatment and I know there is till some room for improvement. Would I benefit from another subcision or laser again? My derm said it'd be difficult on my temples, why is that? I thought of fat grafting, but can't find anyone in the UK that specialises in scar revision fat grafting. Above are before and after of my profile.

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Individual subcisions for treating boxcar and rolling scars and TCA CROSS for treating ice pick scars and dilated pores, while completely different procedures for differing problems, each usually requires between two to four and sometimes up to six separate treatment sessions to achieve optimal improvement (i.e. between 60-89% overall improvement in appearance). Clearly the before and after photos evidence significant improvement. However, if additional improvement is desired, it would not be unreasonable to consider additional subcisions and TCA CROSS for certain areas. While the idea of permanent fat grafting is enticing, just bear in mind that should an adverse reaction occur, there is no simple dissolving enzyme to rid one of the undesired fat. What's more, also bear in mind that fat retains the properties of the region from which it is typically taken (i.e. hips, belly or thighs) and with aging, when those areas begin to show midriff bulge, the same may occur in the fat transplanted to the face. Hope this helps. Best of luck.

Would I benefit from more subcision and fully ablative laser? (photos)

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Would I benefit from more subcision and fully ablative laser? (photos)

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