Orange peel skin texture & acne scars - how to improve skin texture? (Photo)

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. ​"

The gold standard for treating acne scars is energy-based procedures. Due to altered wound healing with acne scars the underlying fibrotic scar tissue can be severe and create a lumpy, uneven texture on the skin's surface, often referred to as "orange peel" or "rolling" scars. While these scars may NOT appear particularly severe on the surface, the underlying fibrotic tissue can make them difficult to treat with peels, micro needling, clear and brilliant kind of superficial treatments.
To address this issue, a technique called subcision can be used to break up the fibrotic scar tissue beneath the skin. This involves inserting a small needle or a blunt cannula under the scar and gently moving it back and forth to release the fibers that are holding the scar in place. One may require several sessions of subcision and combination of energy-based treatments. Once the fibrotic tissue has been loosened, a series of multimodality treatments, such as FRF, AFL, or NAFL laser therapy, with or without PRP/ EXOSOMES can be used to encourage collagen production and smooth out the surface of the skin.
The International Consensus on Acne Scars 2022 recommends a comprehensive approach to treating acne scars, including combination therapy with various modalities. This may involve a series of treatments over several months, with the order and timing of each treatment tailored to the individual patient.

When using lasers as part of a multimodality approach to treating acne scars, it's essential to use appropriate safety settings to minimize the risk of adverse effects such as hyperpigmentation or hypopigmentation. This may include adjusting the laser energy, pulse duration, or spot size to match the patient's skin type and color.

In conclusion, a multimodality approach to treating acne scars that resemble the texture of an orange peel may involve combining subcision with AFL, non-ablative fractional laser, FRF, PRP, or exosomes. It's important to consider the patient's skin type and color and to use appropriate safety settings when using lasers. Consulting with a dermatologist/physician who has experience with treating acne scars in patients with skin of color can help ensure a safe and effective treatment plan.