How should I go about treating my acne scars? (Photos)

Question

My plan: Step 1 - TCA cross for ice pick and boxcar scars Step 2 - subcision for big boxcar scars and rolling scars Step 3 - TCA peels and CO2 laser treatments to diminish the scars more Step 4 - finishing off with fillers for the most stubborn scars Is this a good plan? Thank you and all help is appreciated.

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

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

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. Yes, this is a good plan to begin with as a general staging approach, and many acne-scar treatments are in a similar order — starting with targeted work on the deepest or most resistant scars (like TCA CROSS and subcision) before moving to global resurfacing (TCA peels/CO2) and finally touching up with filler where needed.

Nelson Lee Novick, MD · Answer

Here are some tips for keeping things simple from my experience in several decades of treating acne scars of all types in all skin types:

Field Subcision for overally improvement of all scars. 
Then, for whatever individual sites may still bother you:.
      TCA CROSS; For ice pick scars, dilated pores, and very, very narrow boxcar scars
      Individual Subcisions for boxcar and rolling scars.
Note: TCA CROSS used for wider-based boxcar and rolling scars may risk actually widening them. 
          Ablative CO2 treatments, much like oldstyle aggressive dermabrasion are expensive, have 
          significant post-treatment downtime, run the risk of persistent or permanent skin dyspigmentation, 
          particularly in persons of skin of color, and risks leaving the skin with a permanent, glossy, orange 
          peel appearance. "Buyer Beware!"
Hope this helps and best of luck.

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