Is subcision with filler the proper procedure for my rolling/boxcar scars around my cheek and temple? (Photo)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

you will need long term lasers and microneedling RF with subcision and filler. subcision and filler alone will give you some improvement but not huge, you need textural changes and long term collagen inudction.  peels like cosmelan at home and dermarolling will help you between or before lasers.
Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer.  

Subcision was introduced over twenty five years ago and is considered a simple, relatively inexpensive and proven treatment technique, particularly for acne boxcar and rolling scars. When an entire area, such as the temple, shows generalized atrophy (tissue shrinkage related to acne scarring), a "field subcision" may be performed first, after which individual subcisions may be performed for further improve any individual scars that still remain aesthetically bothersome. Not uncommonly the field subcision alone is sufficient to elevate and smooth overlying scars sufficiently so as to mitigate the need for individual subcisons. The cheeks may be dealt with in a similar fashion. The addition of PRP simply adds considerable expense to the procedure and claims for its benefits to date largely remain unsubstantiated by hard science studies. Besides, subcisions by themselves, create pockets of blood under the skin and within the broken up scar tissue that contain growth and wound healing factors that promote new, native collagen and elastic fiber synthesis. The addition of biostimulatory filler at the time of subcision can further promote synthesis of new, healthy collagen and elastic fibers. Make sure that you consult with a board certified aesthetic physician with experience and expertise in acne scar treatments. Best of luck and stay safe.