Which procedure would you recommend for acne scars, fine lines, large pores and overall tired looking skin? (Photo)

I have acne scarring and large pores and some fine lines starting an overall tired skin appearance, what procedure would work best for me?

Doctor Answers 8

The best treatment for acne scars is not a single procedure, but a combination of procedures in a treatment strategy

Thank you for your question. You submitted 2 photos to help provide some guidance about your situation, asking what procedure is best for acne scars, enlarged pores, fine lines and tired looking skin.

I can help  you with understanding how a physician strategizes similar issues to yours. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years, and helping people rejuvenate their skin is something we do every day in our practice. This is a type of question where you will get many different permutations of answers because everyone brings their own perspective and priorities on the best way to address the issues.

It is important when you meet with a doctor that you provide some guidance. It is understandable how often people come to our practice with these types of issues and they’ll just say, “What do you recommend?” I try to help by breaking down what the problems are that may have a single solution, and what problems require ongoing treatment, and also skin maintenance which is a very important part of the overall benefit.

Acne scarring is one of the most challenging problems in the aesthetic field. Every year, there are new light energy-based devices, and different ways claiming to be the best solution for acne scars, yet every year, more come out because they’re not as perfect as they claim. It is an intrinsic problem that an energy-based device or laser isn’t going to be a single solution, but it can be a part of a solution.

With acne scars, the challenge is to first have a good strategy, but it requires a proper diagnosis. When I evaluate patients with acne scars, I take very detailed photos, and examine them with back lighting to look at the shadows that are the result of volume loss in different levels of the skin. It is important to diagnose the type of acne scar before you start with the strategy because not all acne scars are the same: ice pick scars, boxcar scars, rolling scars, and atrophic scars, with all of them having a certain strategy to improve them. I’ve also noticed there is a fair amount of freckling and sun exposure, so other solutions do include lasers. For the fine lines from sun exposed skin, the skin needs some collagen.

A strategy we employ for patients in terms of collagen building is platelet-rich plasma (PRP). Platelet-rich plasma (PRP) is derived from your own blood, and is a concentration of the wound healing factors necessary when you have a cut. Platelet-rich plasma (PRP) can be applied through injection, and can also be applied topically after a procedure like microneedling. Microneedling is a technique of using fine needles to create little holes in the skin intentionally to do 2 things: one is to create a wound healing response, and two is to deliver something like platelet-rich plasma (PRP) as well as other topical active ingredients to help improve the skin.

I think that it is important for you to get comfortable with a single physician who can guide you with all of these different options. There are infinite possibilities, but when I do a consultation with the patient, I it is also important to understand the capabilities of the doctor in terms of time and resources allocated for all the remarkable things we’re capable of doing. I try to help them reach a certain ideal endpoint that will be part of a journey of continual treatment to get the optimal result.

One last part of this equation is skincare, skin products, and things you can do at home. A system has to be developed, and an understanding of the treatment plan optimally suited for you. It can include platelet-rich plasma (PRP) for collagen buildup and skin quality improvement; laser whether it is fractional, non-ablative, and non-ablative fractional lasers; microneedling; and also injectable fillers. There are certainly a lot of different options to consider, as well as  topicals including retinols, sunblock, good moisturizers and even peels.

A photo is a one part of the process, but the real answers come from proper examination. You need to become comfortable with the doctor who guides you throughout this journey. Very often physicians and non-physicians are more about the transactions - they have a new laser, which they want to use for everything. If they have a new device, or a single strategy they apply to everybody, you have to get the feel from the doctor.  If you are comfortable, begin your journey, and hopefully you reach a point where you feel it was worth the process. I hope that was helpful, I wish you the best of luck, and thank you for your question.

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New York Oculoplastic Surgeon
4.3 out of 5 stars 66 reviews

Acne Scarring -- Lasers (Fraxel, Co2/Erbium, VIVA, Intensif); Microneedling/PRP, Fillers (Bellafill); Subcision; Punch Excision

I suggest a formal consultation with an acne scarring expert. You will need a combination approach with lasers, TCA cross, peels/skin care.  Best, Dr. Emer.

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.9 out of 5 stars 179 reviews

Fraxel

Fraxel is a laser skin rejuvenation treatment that resurfaces your outer skin, erasing imperfections. It also encourages the production of collagen, a protein found in connective tissue.The result is clearly visible lines, folds and wrinkles. Fraxel laser skin rejuvenation is a non-invasive technique that affects only about 20 percent of the facial skin exposed to it. The most common side effects of Fraxel laser treatment are swelling and skin redness, which should subside within a couple of days. Other temporary side effects may include minor itching, dry skin, peeling or flaking, and a bronzed skin appearance. The risk of infection or scarring is very limited. You should stay out of the sun 2-4 weeks.

Elliot M. Heller, MD
New York Facial Plastic Surgeon
4.6 out of 5 stars 90 reviews

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 Hi thanks to share your concern,to begin with a basic skin care regime with topical retinoids and an  exfoliating face wash is suggested.after good skin priming you can do chemical peeling in sessions to even out your fine lines and to improve your acne scars.please do consult a board certified dermatologist and plan your treatment.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.