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

Question

Orange peel and acne scars Hello, What treatments can I do to improve my skin texture? I’ve have microneedling, chemical peels, one round of clear and brilliant, and I’ve tried PRP. My acne scars have improved, but minimally. I would like to know if there are any other options to improve my skin texture."

Randal Haworth, MD, FACS · Answer

There are a few other options that you can explore to improve your skin texture and address your orange peel and acne scars. Here are some treatments that you may consider:

Fractional laser resurfacing: This treatment uses laser energy to create microscopic wounds in the skin, stimulating collagen production and promoting skin renewal. Fractional laser resurfacing can improve skin texture, reduce the appearance of acne scars, and even out skin tone.
Dermal fillers: Injecting dermal fillers into the skin can help fill in depressed acne scars and improve the texture of the skin. The effects of dermal fillers are temporary and may need to be repeated periodically to maintain results.
Subcision: This is a minimally invasive procedure that involves using a needle to break up the fibrous bands that are pulling down the skin and causing the depression in the scar. This allows the skin to lift up and smooth out, improving the appearance of the scar.
Dermabrasion: This is a surgical procedure that involves removing the top layers of skin with a rotating device. Dermabrasion can help improve skin texture, reduce the appearance of acne scars, and even out skin tone.
It's important to consult with a dermatologist or a plastic surgeon who specializes in treating skin texture issues and acne scars. They can assess your skin condition and recommend the most suitable treatment options based on your needs and goals. Keep in mind that the results of these treatments may vary, and multiple sessions may be necessary to achieve the desired outcome.

I hope this helps,
best of luck !

Raffy Karamanoukian, MD, FACS · Answer

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

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. ​"

Shanthala Shivananjappa, MD · Answer

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.

Nelson Lee Novick, MD · Answer

Unfortunately, there is no substitute for an in-person examination that allows for palpation and manipulation of the skin. However, at least from the one photo provided, it would appear that a Field Subcision would help to create smoother skin and diminish the overlying acne scarring and dilated pores. Some comments are in order, however, regarding the previous treatments. In general, both manual microneedling (no need for the extra risk and expense of added RF) and superficial chemical peels typically require a series of between two to six  (on average 3 or 4) treatment sessions to be successful. So, if you have had only one or two sessions of each, then you might wish to consider revisiting these options. Here-today-gone-tomorrow, expensive light and energy-based devices are unfortunately backed by little hard science and an whole lot of marketing, advertising and social media hype, and the same can be said of PRP; so, no surprise about your disappointment with these. Sorry. On the other hand, a Field Subcision, which has proven both safe and effective for nearly three decades in all skin types, can provide the needed stretch to the overlying skin to smooth it and thus diminish the appearance of the overlying dilated pores and ice pick scars and to increase all-important light reflectivity. Any remaining troublesome ice pick scars or dilated pores can then be treated with TCA CROSS, another procedure with a more than two decades long track record for safety and efficacy in all skin types--although this is unlikely to be needed. Make sure to consult with an experienced, board certified cosmetic dermatologist and best of luck.

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

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