Is superficial or deep filler better for acne scars? (Photo)

Question

I have been advised by one clinic to get Belotero filler superficially injected for my acne scars, and another has recommended Juvederm injected deeper into the skin. Which would be likely time have better results? (Already had several lasers and microneedling) Thanks

Ryan Mitchell, DO, FAOCO · Answer

Hello, Thank you for your question. It is your duty to find a qualified, licensed practitioner to treat your medical problem.   Because we are dealing with a cash business, you’re going to find a plethora of “people” wanting your money to attempt to correct your acne scarring sequela.   While the laws regarding who can legally inject dermal fillers continues to become more just, there are numerous “injectors” that simply aren’t qualified with knowledge nor experience to treat you with confidence. That is why you are getting various opinions as to where the filler should be injected.   As part of a consultation, you deserve an explanation regarding your particular dermatologic condition, the types of scars you have sustained and treatment options that are available to improve your condition. You can be told that the filler needs to be injected superficially or it needs to be injected more deeply but the truth of the matter is it needs to be injected properly.   Also, you may benefit from more than only filling into the correct plane. You would benefit not only injection of the filler but for more of a procedure that includes “undermining” the scars first. You present with a condition that should be treated by a well-experienced physician because you do not present with a simple “filler” case. You demonstrate acne scars of the valley or rolling type.  In order to best improve your scars long-term this is going to take a plan of action.  Have you looked into Bellafill?  Bellafill is a permanent filler. It’s just one option. I am not suggesting it’s your only option. Or, are you going to use temporary fillers that will  last you a few months time that require repeated injections over and over?  Most injectors don’t want to use Bellafill because they don’t have the confidence even though it may be the most efficacious and cost-effective solution to your problem long-term. I suggest you find an injector that offers you a full complement of services as well as the confidence and wherewithal to properly treat your condition. I wish you the best of luck in your endeavor and please choose your provider with care.

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

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. - Subcision for depressed, tethered scars. - Vascular lasers like Yellow laser, Aerolase, excel V, or IPL for redness or thick acne scars. - Lasers such as Fraxel, Erbium, CO2 or fractional radiofrequency (Venus Viva, Skinfinity, Intensif microneedling RF) for textural issues and superficial scarring. - TCA CROSS and punch excision for deep ice pick scars and narrow box car scars. 
All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer.

Nelson Lee Novick, MD · Answer

First, let me say that I am hardly surprised that you were disappointed with your laser treatments, as I have been cautioning readers for years that these supposedly relatively expensive, "next big thing" bells and whistles are far more backed by device manufacturer supported marketing hype than hard science. Although microneedling, properly performed by a professional, can be helpful for acne scars, it has been my over twenty years of experience with it that it is best reserved, as a final step, for treating residual color and textural problems after other more effective treatments have been employed. Subcision, which I have been performing for over twenty-five years, works well for elevating and smoothing acne scars. Although I typically supplement subcision with the use of a filler (primarlly for its ability to help promote new, native collagen and elastic fiber synthesis, rather than its much more temporary function to plump and elevate), I would suggest great caution in its use in this glabella and mid-forehead region, since this highly vascular region poses an increased risk for blood vessel occlusion. If a filler is used, I would suggest a very superficial injection technique and Belotero Balance would be a reasonable choice for this. Absolutely make sure that you are consulting with an experienced aesthetic physician and acne scar specialist. Best of luck.

Paul Charlson, MBBS · Answer

Sorry to hear of your problem.There is little research on this.If your scars are tethered subcision with a cannula helps.I also use cross TCA on these scars.As to filler as long as it lifts and fills the scar it helps Superficial fillers tend to be softer and show less but last a shorter time. Collagen stimulation using dilute PLLA is interesting and I've been getting results with this .

Martie Gidon, MD, FRCPC, FAAD · Answer

Acne scarring requires a combination of treatments. Excision, subcision, TCA Cross, laser, RF microneedling and fillers may be required for some scars. Please consult a cosmetic dermatologist who offers these treatments and can plan an individualized program for you.

Matt Tahsini, MD · Answer

Hello and thank you for your question. I understand this can be very frustrating to get different answers. Have you had any luck with the laser and microneedling treatments? I have done many laser and microneedling procedure over the years and they seem to have a good success rate. I suggest an in person consultation in order to plan your path forward. Best wishes.Dr. T

Center for Aesthetics and Plastic Surgery - Grand Rapids · Answer

Hello there,
       Honestly, it may take a combination to give you the results you are looking for. I have used both techniques, and it really depends on the area, the scar, the patient..etc. Based on the photo, it appears that this is the forehead, so typically a more superficial filler would be used since the skin and tissue is thin. Hope this helps. 
Sarah RN BSN

Alix J. Charles, MD · Answer

Thank you for your question. While I do think you could use Belotero, your “rolling” acne scars might also respond nicely to subcision followed by Bellafill injections. Alternately, a combination microneedling +  radiofrequency device like Profound by Candela could also boost your own collagen and elastin to help fill these scars. Make sure you find someone with the skill and experience to treat these problems, and best of luck to you!

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Have a consultation with a certified physician.  There are many options. Fillers and well as procedures. See an expert! Best of luck..

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