Can I do filling for these scars? (photos)
Doctor Answers 9
Combination treatments do best.
My approach would be to treat each scar type with an optimal treatment. You may require subsection, fractional and ablative lasers. I reserve fillers for atrophic scars that don't respond to CO2 Fractional laser. I suspect you will have some residual scars that will require Juvederm.
Dr Davin Lim
Fillers for Acne Scars
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Ice Pick Scars May Respond Well To the CROSS Technique
It has been my experience that ice pick scars respond better to the CROSS Technique, which uses TCA in a 90%-100% concentration instilled down the shaft of the scar to shrink it down and tighten together the walls of the scar. Following this would be a good time to consider microneedling to blend the treated areas in tone and texture with the surrounding normal skin. Microneedling, as you have unfortunately already learned, helps only somewhat when performed beforehand.
Scar Treatments for Ice pick scars
Your photo was very helpful. The best way to treat these scars would be with either the eMatrix or Fraxel laser. Some very deep scars can be improved with a hyaluronic acid filler and I inject a lot of scars with these fillers. A combination approach would be best in your particular case. Please consult a board certified dermatologist for the best cosmetic results who has experience with these lasers.
Acne scar treatment
Good treatment options for acne scars and discoloration can include lasers (traditional or fractional), dermabrasion (not mircrodermabrasion which would be a waste of money) and deep chemical peels. You have to be careful when using traditional lasers (CO2) and deep chemical peels and dermabrasion on dark skin types (like Asian skin) as they have a higher risk for uneven pigmentation and post- inflammatory hyper- pigmentation. Fractional lasers have less risks for uneven pigmentation, especially for darker skin types (Hispanics, Asians). Tissue fillers (Juvederm, Restylane, ect.) can often give instant improvement for depressed acne scars that are not too tethered down or not too small. They are less expensive but are a temporary fix and have to be re-injected. IPL (intense pulsed light) can be especially good for discoloration (red and dark) as that is one of it's primary indications, is very affordable and involves little down time with the least amount of risks (multiple treatments are required). IPL is also great for large pores and oily skin. It is also safer on darker/ Asian type skin and has less risks for hyper- pigmentation than laser and chemical peels. It is not a stand alone procedure for deep acne scars as you would still have to do one or more of the other treatment modalities. I would recommend you see a board certified physician who has a lot of experience using these treatment modalities to assess your needs, discuss the advantages and disadvantages and risks and to recommend the ideal procedure for you. Best wishes.
Although you did not get a good response to Microneedling, I feel that aggressive deep (2mm) multiple(At least 3 to 4)microneedling with PRP has been the most successful. An alternative that I suggest is ablative microneedle radiofrequency.
Consult a doctor with experience who will show you pictures.
Numerous small acne scars are best treated with the Infini
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