41, always struggled with acne. What can I do to improve my skin? (Photo)

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing.

As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.
If you have ice-pick scars, we recommend RF ablation and TCA Cross.
Best,
Dr. Karamanoukian
Realself100 Surgeon

It sounds like you’ve tried many treatments, but persistent acne and scarring often need a multi-step approach—especially if past treatments didn’t give lasting results.
A board-certified Doctor may recommend:
Hormonal evaluation: Sometimes acne at 40+ can be hormone-driven, so labs or adjusting medications like spironolactone may help.
Advanced treatments: Combination therapies like RF microneedling + chemical peels or fractionated laser resurfacing can improve both active acne and scarring over time.
Medical skincare: Prescription retinoids, azelaic acid, or low-dose oral meds can maintain results long-term.
Lifestyle factors: Diet, stress, and gut health can sometimes play a role too.

From the photo provided, the acne scars around the chin are papular acne scars--essentially hypertrophic acne scars that typically affect the chin and nasal regions (although other areas can be affected, as well). These kinds of scars will not respond to acne medications. They can be treated in three ways: 1) Scalpel Sculpting, to literally "sculpt" them off flush with the surface of the skin; 2) intralesional injections of an ant-inflammatory agent; 3) low intensity electrocautery. I typically perform a test of each treatment modality on one scar and all the remainder will be treated with whichever method proves best for that individual. You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck

Thank you for sharing your concerns and photo. It looks like you’re dealing with residual scarring from long-standing acne, along with some active breakouts. Since you’ve already tried multiple medical and procedural options (topicals, antibiotics, spironolactone, isotretinoin courses, Morpheus8, CO₂ laser), your situation falls under refractory acne and acne scarring, which can be very challenging but not hopeless.

Here are some tailored considerations:

Active Acne Control

Even after multiple treatments, some people benefit from combination therapy (hormonal + topical + procedural).

Topicals with retinoids (tretinoin, adapalene), azelaic acid, or dapsone gel may help ongoing breakouts.

If hormonal triggers are suspected, sometimes adjusting spironolactone dose, or adding other hormonal regulation, can help.

Scarring Management

Subcision (to break up tethered scars) followed by collagen-stimulating treatments can give noticeable improvement.

Microneedling with PRP or radiofrequency microneedling sometimes works better when alternated with subcision.

Fractional lasers (erbium or fractional CO₂) in staged sessions can continue to remodel scars, especially when combined with filler or biostimulatory injectables (e.g., Sculptra, Radiesse).

Skin Texture & Boosting Collagen

Collagen stimulators or dermal fillers placed strategically can help elevate depressed scars.

Topical growth factors, peptides, and retinoids are supportive in between procedures.

Emotional & Functional Aspect

Persistent scarring often affects confidence as much as appearance. Many patients benefit from knowing that multi-modal, stepwise treatments — not one single fix — usually achieve the best results.

Summary: At this stage, the best approach is usually a combination plan targeting both the scars and any ongoing breakouts, often including subcision + biostimulatory fillers + microneedling/laser resurfacing, while maintaining acne suppression with topical or hormonal therapy.