Is laser resurfacing my best shot at treating these acne scars? (photos)

Question

Hello, could you please help me understand what type of acne scarring do I have---is it hypertrophic? And also would a fractional CO2 laser be the best, TCA cross or just microneedling?

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

​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. ​

A.J. Amadi, MD · Answer

Looking over the submitted photos, the scar tissue does not appear to be hypertrophic and more like ice pick scarring. I would recommend the fractional CO2 laser followed by microneedling. It is important to keep in mind that when working with scar tissue, the skin may never fully become completely smooth. It is always best to meet with a provider in person to go over the best plan for achieving your skin goals.

James R. Gordon, MD, FACS, FAAO · Answer

Thank you for sharing your question and posting your photos. Acne scars are tricky to treat. Usually a few sessions with an erbium laser make a dramatic difference. See an oculoplastic surgeon with great experience using the erbium laser. Good luck!

Richard Ort, MD · Answer

From the limited photos provided, I would recommend starting treatment with TCA CROSS for ice pick and small box car scars. Multiple treatment sessions would be recommended for best results. It’s possible that lasers or other treatments might be beneficial as well. It would be necessary to see you in person to provide a definitive recommendation. 
Best,
Dr. Ort

Is laser resurfacing my best shot at treating these acne scars? (photos)

Answers (5)

Answer: Treatment for Acne Scars

Answer: Treatment for Acne Scars

Answer: Best shot at treating acne scars

Answer: Best shot at treating acne scars

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Is laser resurfacing my best shot at treating these acne scars? (photos)

Answers (5)

Answer: Treatment for Acne Scars

Answer: Treatment for Acne Scars

Answer: Best shot at treating acne scars

Answer: Best shot at treating acne scars

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Recommended reading

Everything you need to know about Laser Resurfacing

Our mission is to create a world where every investment in modern beauty is Worth It.