Best time to treat new acne scars? When is the best time to do a procedure like CO2?

Question

Hi, just wondering when is the best time to treat new acne scars? I have old acne scars on my face and haven’t had acne in years up until a couple of months ago I broke out, less then 15-20 pimples but I’m afraid that they will scar. I have my acne under control now but have like one or two pimples here and there. I would like to treat the acne scars early before they scar since I’m likely to scar anyway. They are just flat red spots now. When is the best time to do a procedure like co2?

Nelson Lee Novick, MD · Answer

It is very important to make sure that your acne breakout is completely controlled. Remember, it was active acne that led to scarring of your normal skin and, in much the same way, it can be fresh acne breakouts that can set back any attempts to improve existing scars. So, acne under control for at least a couple of months consecutively is the first order of business. Once the active active flares are suppressed, then certain tried and true, relatively inexpensive treatments that have stood the test of decades for safety and efficacy in all skin types may be used to treat the scars. For generalized acne atrophy of the cheeks and/or temples, think Field Subcision. For individual boxcar and rolling scars, think subcision. And, for ice pick scars and dilated pores, think TCA CROSS. All other treatments, like fraxel lasers and other relatively expensive energy-based RF and ultrasound devices to date have far more marketing hype to support their use than any hard science. So, buyer beware. Hope this helps and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin. 
 
Best, 
Dr. Raffy 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.

Milan Shah, MD · Answer

The optimal time to treat new acne scars can depend on the type of scars and the specific treatment you're considering. It's important to consult with a healthcare professional who can assess your individual situation and recommend the most suitable approach. However, there are some general considerations:1. Early Intervention: Treating acne scars sooner rather than later can be beneficial. Early intervention may help prevent the scars from becoming more pronounced and may result in better outcomes.2. Active Acne Management: Before addressing acne scars, it's essential to manage active acne. Treating existing acne can help prevent new scars from forming during the healing process.3. Post-Inflammatory Erythema (PIE) vs. Post-Inflammatory Hyperpigmentation (PIH): Differentiating between red (PIE) and brown (PIH) marks is important. Certain treatments, such as lasers, may be more effective for one type of pigmentation than the other.4. Depressed Scars: For depressed scars, procedures like laser resurfacing, including CO2 laser treatment, may be considered. These treatments can help stimulate collagen production and improve the appearance of scars.5. Recovery Time: Keep in mind that procedures like CO2 laser resurfacing may require some downtime for recovery. It's important to plan the treatment when you can take time off from work or social activities to allow for proper healing.6. Sun Protection: Sun protection is crucial both before and after any procedure to minimize the risk of pigmentation changes. Avoiding sun exposure and using sunscreen are essential components of scar management.Remember that individual responses to treatments can vary, and the appropriateness of a specific procedure depends on factors such as skin type, scar type, and overall health. Always follow your healthcare professional's recommendations regarding pre-treatment preparation and post-treatment care.Discuss your concerns and goals with a healthcare professional who can provide a thorough assessment and recommend a treatment plan based on your unique skin characteristics and scar type.

Best time to treat new acne scars? When is the best time to do a procedure like CO2?

Answers (4)

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