Acne scars are worsening, should I consider co2 laser or bellafill? What is my best option? (photos)

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

"​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, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, 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. ​"

Close-up HD photos would have been very helpful. At least from what can be seen in the photos provided, there appears to be boxcar and rolling scars and some mid to lower cheek generalized acne scar-related atrophsy. If this is indeed so, then properly performed manual Field Subcision by an experienced cosmetic dermatologist should help to diminish the scar-related generalized volume deficit that is both making the overlying individual scars appear worse, but is no doubt contributing to the development of the smile lines and incipient marionette lines. The Field Subcision should help to address all these issues. Once done, any particularly bothersome boxcar and rolling scars may be treated by individual subcisions complemented, if deemed necssary, by a medium potency TCA CROSS treatment. I have personally been performing subcisions since 1995 and TCA CROSS for well over twenty years with very gratifying results. C02 laser is a relatively expensive aggressive treatment (much like dermabrasion and deep chemcal peels in that regards) that engenders signficant post-treatment downtime and carries the risk of scarring and/or the development of a permanent, unnatural, overly smooth and shiny appearance to the skin. Bellafil, like other permanent fillers, carries the risk for adverse reactions, such as nodules and granulomas, that may occur soon after treatment or as many as five, ten or twenty+ years later following some manipulation of the skin, such as during dental work. You would be wise to make sure that you consult an experienced scar specialist. Best of luck.