What is the best treatment for my acne scars?

Question

I'm wondering if there are any minimally invasive procedures such as microneedling or fractal C02 laser that would make a noticeable difference in my acne scars? I've attached two photos of the right side of my face. Each photo is taken in the same spot with a DSLR camera at 100 ISO from 5 feet away digitally zoomed in 100 percent. The first photo is in direct sunlight. The second has a variety of shadows due to moving cloud cover.

Nelson Lee Novick, MD · Answer

At least from the photos provided, a Field Subcision would very likely smooth considerably the overlying acne scars. Following this, individual subcisions may then be performed, if so desired, on any residual individual rolling, boxcar scars to further elevate and smooth them. To date, the expensive "bells and whistles" devices, such as the fraxel lasers and RF machines, have far more marketing hype than hard science to back up their use. So, exercise a healthy dose of "buyer beware" when these are hawked to you. Remember, these expensive gizmos are all too often "here-today-gone-tomorrow" fads and are the subject of so much unreliable information on Drs. TikTok and Instagram, whereas Subcison, which I have been performing since 1995, has a several decades' long track record of safety and efficacy for elevating and smoothing all kinds of acne scars in all skin types. You would be wise to consult with a board certified cosmetic dermatologist scar treatment specialist and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jeff Rapaport, MD · Answer

Treatment of your depressed acne scars, such as boxcar and saucer-shaped scars, often involves a combination of procedures. Options include:
1. Dermal Fillers:Injectable fillers like hyaluronic acid can be used to raise the depressed areas of the skin, making the scars less noticeable.
2. Laser Therapy: Various types of lasers, such as fractional laser therapy, can stimulate collagen production and improve the appearance of acne scars by resurfacing the skin.
3. Microneedling:This procedure involves using a device with fine needles to create controlled micro-injuries in the skin, stimulating collagen and elastin production, which can help improve the appearance of acne scars.
4.Subcision:This surgical procedure involves breaking up scar tissue beneath the skin with a needle or blade, allowing the depressed area to rise and become more level with the surrounding skin.
5.Platelet-Rich Plasma (PRP) Therapy: PRP, derived from the patient's own blood, can be injected into acne scars to promote tissue regeneration and improve skin texture. Find a scar expert.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin. This is a great question. Based on your concerns, I recommend receiving treatments with Morpheus8, which combines microneedling with radiofrequency energy. Morpheus8 is a great treatment to treat acne scars and stimulate collagen production. However, I highly recommend scheduling an in-person consultation in order to better assess your areas of concern and discuss an appropriate treatment plan to help achieve your aesthetic goals. Our office phone number is: (312) 944-0117. I hope this helps and best of luck!

Jeff Kotsubo, DDS · Answer

Exion RF AI micro-needling is great for skin resurfacing and texture remodeling. On average it has been shown to decrease the appearance of acne scars by 41% after the minimal 3 - 4 treatment sessions. This stimulates the production of collagen and elastin. This is less painful than Morpheus8 as this is a single pass procedure, meaning each area is treated once. There is no reason to go over the same area 3 times like Morpheus8. This can be very uncomfortable. While a topical anesthetic can decrease discomfort, many patients do not feel the need for it. Overall, Exion RF micro-needling can significantly decrease acne scars and improve skin texture. Optimum results are seen 3 months after the last treatment session.

Barry Kusman, MD, FACS (retired) · Answer

Hello, 
Here at Facial Artistry & Aesthetics we offer RF Microneedling Potenza that combines the advantages of radiofrequency energy with traditional microneedling. It delivers a radiant complexion while addressing common signs of aging, blemishes, acne scars, and more. Potenza is safe, painless, and requires minimal downtime, allowing patients to resume regular activities immediately after the procedure. It is suitable for all skin tones and types, making it an ideal choice for individuals of all ages and skin colors. If you are interested in booking a free consultation and would like more information please contact our office at 520-790-1234. Thank you.

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