Acne Scar Subcision + HA Fillers VS Sculptra for rolling acne scars? (Photos)

Question

I’m suffering from rolling acne scars on the temples. I have had laser done multiple times as well as subcision performed twice in the past, but no filler was placed afterward. Only recently was it explained to me that subcision alone is probably less effective due to re-tethering if the released space is not supported during healing with a filler. I recently consulted with an acne-scar specialist who recommended an aggressive approach: CO2 laser + TCA CROSS + subcision with Sculptra (PLLA) placed afterward to act as a scaffold so scars don’t re-tether. I’m hesitant about Sculptra because of its longevity and the possibility of nodules in the thin temple area. My questions: Could HA filler (such as Restylane or Belotero) be used instead as a temporary scaffold to prevent scars from re-tethering? If HA filler were maintained with touch-ups over 4–6 months after subcision, would that typically allow enough collagen remodeling for long-term stabilization so the scars don’t retether? How risky is Sculptra in the temple area? Very fearful of nodules down the line and no options for removal or dissolving. I’m trying to determine whether I can take the less risky approach of submission + HA filler and get the same results even if it means close monitoring and frequent touch ups while the temples stabilize.

Mats Hagstrom, MD (license on probation) · Answer

As you know firsthand, none of the treatments you describe are effective for treatment. Ing acne scars.
If you understand the primary problem, then you should also understand that none of the procedures you describe will effectively treat the problem.
Cutting this scar tissue will only lead to formation of more scar tissue.
The only treatment that works is direct excision of the most prominent lesions.
It’s possible to do meticulous surgery that leaves virtually no scars whatsoever.
Doing this can remove the three dimensional contour irregularity in exchange for an almost invisible flat scar.Obviously, not all the acne scars can be removed, but removing the worst areas that throw, the deepest shadows is a better improvement than treating the entire area with the procedure that doesn’t work.
I suggest you consult with plastic surgeons who have experienced doing direct decision of acne scars, and avoid a dermatologist who aren’t comfortable doing the definitive procedure.
Insist providers show you lots and lots of before and after pictures and bring pictures of yourself to use as a reference.
One or two good examples is totally insufficient, especially if somebody claims to be an expert or be doing these on a regular basis.
They should have at least 20 or 30 examples of previous patients for you to look at.
The concept of using a blade of laser treatments makes absolutely no sense whatsoever.
How is the laser going to differentiate between high and low area
This is an entirely difficult problem to improve and improvement is the best you can ask for.
Look for senior, conscientious, ex experience plastic surgeons or potentially other providers who are comfortable doing meticulous, surgical procedures, not oblated, resurfacing or injections.
Consider leaving reviews for providers who did previous treatments that didn’t work.
Other patients deserve to know.
Best,
Mats Hagstrom MD

Acne Scar Subcision + HA Fillers VS Sculptra for rolling acne scars? (Photos)

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