What would you recommend for my acne scars? (Photo)

I have subcision and juvaderm scheduled for this week to be followed later by total fx. I spoke to another doctor that would like to do co2re followed by bellafill. What would is going to provide the best results? Does anyone know if total fx laser can be done after bellafill injections?

Doctor Answers 3

Differing Acne Scar Types Determine The Optimal Overall Treatment Plan

Unfortunately, treatment is unlikely to be an easy fix in this case, since we are dealing with the presence of fairly extensive facial acne scarring, along with the presence of the whole spectrum of acne scars (boxcar scars, rolling scars, pit scars), as well as an overall underlying area of wasting and depression.

The overall depression of the cheeks can be treated with the use of a volumizing filler, such as Voluma XC, which I would use in my Upper East Side Manhattan office. (In my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are available, I would choose Stylage XXL). This in itself would help to lift and smooth and stretch the overlying skin and make some of the deeper scars appear more shallow and exhibitless of the "craters on the moon" shadowing that make scars stand out more.

Subcision can then be used to free up the scar tethers that bind down the bases of the deeper scars. A small amount of filler injected afterward can provide immediate lift and improvement and also enable an additional biostimulatory effect to increase new, native collagen and elastic fiber synthesis.

I am not a fan of the use of autologous fat injections, which I stopped performing over twenty years ago. The procedure is relatively expensive, requires a two step minimally invasive process to retrieve and reinject with larger bore cannulas, and often, despite the hope, does notalways persist much longer than traditional off-the-shelf fillers.

Finally, fractional microneedle resurfacting can then be used to better blend the tone and texture of the treated skin with the surrounding normal skin. I have been singularly unimpressed with relatively expensive fraxel lasers, radiofrequency, and ultrasound treatments, finding them to be far more device manufacturer supported marketing hype than backed by hard science. In a January, 2016 article in the trade medical publication, The Dermatologist, referring to the treatment of acne scars with microneedling, the following points were made. "This technique is gaining  more interest as it is less costly, has minimal downtime, and fewer side effects than other traditional modalities." 

You would do well to seek consultation with a board certified aesthetic physician with experience and expertise in all forms of acne treatments.

New York Dermatologic Surgeon
4.9 out of 5 stars 29 reviews

Depressed scarring

In my opinion, you have atrophic saucer scars, depressed boxcars, acne pits and ice pick scars. I do believe that your scars need to be lifted. Subcision is the gold standard for lifting scars. I believe there would be a benefit for you to volumize under the scars with RF microneedling (infini). This would give you some lift that is of a long lasting nature. An ablative as well as non ablative  laser would be able to smooth the edges of your scars. TCA cross should work well for your ice pick scars. Lasers do not have the ability to lift scars. For that reason,  I would treat  superficial scars with ablative or  non-ablative lasers. The timing of fillers is personal. I do not like to perform any fillers until other reconstructive treatments are completed. In my mind, permanent fillers  lead to permanent problems. I prefer fillers that can be reversed . For this reason, I avoid any permanent fillers. Find an acne scar expert who is going to show you photos. Hope this helps. Good luck.

Jeffrey Rapaport, MD
Englewood Dermatologic Surgeon
4.6 out of 5 stars 40 reviews

Acne Scars and Treatment

You are definitely on the right track since any combination of fractionated lasers and injections will improve your appearance.  I would prefer that you had Sculptra injected since the results will last much longer and produce more collagen for your skin.  Be certain to consult a board certified dermatologist with a great deal of experience with scars and laser treatments.  Best, Dr. Green

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 76 reviews

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