Would subcision + Bellafill help me with these acne scars, which ruin my self-esteem? (Photo)

Question

I am 25/mixed race male with acne scars. I have done many different treatments (peels, CoolTouch, CO2 Mixto Fractional laser, Venus Viva, Profractional laser) and nothing seems to help. I am considering subcision + Bellafill, and am signed up for a treatment with one doctor. However, I emailed another doctor, and he said "Bellafill is not for boxcar scars. Bellafill would create a ring around each of yours scars but not actually fill in the scar, therefore making things worse." Now, I'm afraid.

Raffy Karamanoukian, MD, FACS · Answer

Acne scars can be caused by inflammation and atrophy of the dermis. We see combination acne scars consisting of atrophic depressed scars, red inflamed scars, and darkly discolored scars. Treatment begins with application of topical scar creams followed by a combination of fractional laser, fractional RF, PRP, microneedling, subcision, and fillers. 
  
Topical scar protocols for acne scars include the following: 
  
Melarase AM
  Melarase PM
  Melapads
  Replenish Retinoid Cream
  Once topical creams have been started, a protocoled regimen includes fractional RF and laser. 
  
Best, 
  
Dr. Karamanoukian
  
Realself100 Surgeon

Jason Emer, MD · Answer

this needs more than just subcision and bellafill, which would help.  under . this you need volume in your face either fat , sculpra or someething with longer longevity like radiesse.  also you need more lasers ... likely you needed at least a series of 3-6 treatments such as microneedling RF and a few CO2s to see an outcome. I suggest you see an acne scarring expert who can put you on a treatment plan but long term you will need therapies.  Best, Dr. Emer.

Jeff Rapaport, MD · Answer

Without viewing your photos, it is difficult for me to comment on the effectiveness of bellafill in your case. Traditionally, bellafill is used for saucer shaped cars. I would consider using a hyaluronic acid as a test. This can be dissolved with vitrase should the results not be successful. If you are happy, use the bellafill.
Acne scar nj.com

Johnson C. Lee, MD · Answer

Thank you for your photos. Bellafill is definitely an option for you, but since you have different types of scars, you will likely need other treatments done as well for maximum improvement. The deeper wide scars can be released and filled in with subcision and a filler such as Bellafill which is specifically designed for divets and depressions left by acne. The very thin or deep ice-pick scars are best treated by excising them completely.  The more superficial scars work better with a combination of a chemical peel for the hyperpigmentation and acne control, microneedling with PRP for texture and collagen building, and PIXEL fractionated laser or RF to resurface and build even more collagen. Not everyone is a candidate for all the treatment options however as certain skin types can get worse from certain treatments. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon
@drjohnsonlee

Michele S. Green, MD · Answer

It is difficult to tell from the photo but it appears that a combination of fillers, eMatrix and Sculptra would be the best treatment with your type of scars and skin type. I do a lot of Bellafill but you will need Sculptra to help the underlying collagen loss from the scar tissue. Please consult an expert in acne scars.  Best, Dr. Green

Davin Lim, MBBS, FACD - Account Suspended · Answer

Acne scars MUST be evaluated in real time for the most accurate treatment plan. Examination also includes touch to ensure you do not have fibrosis (hard collagen- scars). Subcision and filler may help, you will need several treatments combined with energy based microneedling RF or low density high energy fractional lasers. Dr Emer, Dr Novick, Dr Rapaport, and Dr Weiner are experts in the US. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments methods. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
  
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, INFINI –Intensif –Intracel radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, PRP or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers.
 
  
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination or touch will give us an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
  
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

Would subcision + Bellafill help me with these acne scars, which ruin my self-esteem? (Photo)

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