How severe and what type of acne scars do I have? (Photos)

Question

Depending on the lighting, my acne scars can seem either superficial or severe, and I can't tell! When I stretch my skin, they mostly disappear (maybe by 85-90%). I also can't tell what type of acne scars these are - I always assumed rolling, but could some of them be boxcars? How much improvement might I be able to see? Do I need subcision? Could I potentially go without it?

Raffy Karamanoukian, MD, FACS · Answer

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing.
 
As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.
If you have ice-pick scars, we recommend RF ablation and TCA Cross.
Best,
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

In answer to, "Do I need it?",  I would emphasize that if you look in the mirror and are satisfied with what looks back at you, you do not not need it. If you are not satisfied, then you have your answer. This is entirely aesthetic decision, no a medical one. So, only you can and should answer the question.
From the photos, as best I can tell from what you provided, there seems to be the general mix of rolling, boxcar and even ice pick scars. So, if you were to opt for treatment, and since the skin smooths when you stretch it, a Field Subcision would be in order, after which, if there are still any particular boxcar/rolling scars that still bother you, individual subcisions to elevate and smooth them can be performed. Finally, if desired, any ice pick scars can be treated with TCA CROSS. For mature scars, I.e. those older than three months of age, a 60-80 percent overall improvement in appearance can be expected.
Each of the above-mentioned procedures, which I personally have been using for decades, has a proven track record for safety and efficacy in all skin types. Exercise a great deal of buyer beware caution when being hawked this or that expensive, light or other energy-based treatments, as these bells and whistles are backed far more by heavy marketing hype and social media buzz than hard science. Hope this helps and best of luck.

How severe and what type of acne scars do I have? (Photos)

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How severe and what type of acne scars do I have? (Photos)

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