Should I do Microdermabrasion or Microneedling for acne scars and pigmentation?

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. 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 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 scars and indented 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 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

 Thank you for your question. I would recommend a series of microneedling to heal active acne lesions and smooth out acne scarring and correct unwanted pigmentation from post acne lesions or sun damage. Consult with a dermatologist or medical aesthetician to see what they recommend. best of luck to you.

Unfortunately, the answer is that neither, especially microdermabrasion, is going to be particularly effective for treating true acne scars.  Microdermabrasion, which in the early days, was referred to as "epidermabrasion," is little more than a superficial exfoliation (the kind that you could get at home from the use of a Buf Puf, Loofah, Clarisonic or even the aggressive use of a wash cloth). It will really do little for true acne scars--so save your money and time there, if true acne scar improvement is your goal, rather than simply temporarily brightening your skin and giving it transient greater luminosity.  As to microneedling, a procedure I have been performing for twenty years, it is an excellent method for improving residual superficial surface color and textural irregularities that typically persist following truly appropriate acne scar treatments, such as subcision and TCA CROSS. It will not be particularly effective for treating all but the absolutely most superficial indented acne scars. I feel that besides adding significantly to the expense and time to treatment, PRP contributes little. Experienced microneedlers typically treat until fine bleeding points are achieved, and this small amount of blood likewise contains the desirable growth factors and wound healing factors.  As an aside, you should also exercise a healthy dose of skepticism when evaluating claims for this or that relatively expensive fraxel laser or other energy-based devices for treating acne scars. These "bells and whistles", unfortunately, have been proving themselves to be far more backed by device manufacturer supported marketing hype than hard science. So, "Buyer beware" there, as well. Make sure that you consult with a board certified aesthetic physician. Best of luck. 

Acne scars are difficult to treat. They represent full thickness skin scars and, therefore, require resurfacing to improve. Laser treatments, dermabrasion, chemical peels have been tried. Microneedling appears that have a particular value in improving these scars. Microdermabrasion not so much. Neither is likely to improve pigment issues

Acne scars need a combination approach for improvement. For the best results, one should target the acne scar type. As everyone has a unique pattern of acne scarring, the best solution is a tailored one. Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision. Subcision for depressed tethered scars. Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif microneedling RF for textural issues and superficial scarring. Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision. All lasers are combined with microneedling and PRP to get even better results and improve healing times. The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician. It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome. Scars cannot be cured and will need life-long treatments to maintain and build on the results. Best, Dr. Emer.

Hello NYCx,
Thank you for your question and photos.
I would recommend a series of 3-6 Microneedling treatments to smooth and correct the acne scars and even out the pigmented areas. Continue microneedling 3-4 times a year to maintain the skins appearance. PRP is always recommended with microneedling treatments for quicker healing and optimal results.
Best to you!

Deep Microneedling with PRP works great. While microdermabrasion only treats the surface skin, a deep microneedling treatment will break through scar tissue better.  Deeper treatments aid in collagen production as well as skin resurfacing.  Click on my profile to see some before and after pictures of patients with acne scars treated with microneedling. 

Microneedling with PRP is a better choice over microdermabrasion. Microneedling when performed by an experienced physician is a great treatment for scars and collagen remodeling and stimulation. Microdermabrasion is good for refreshing your skin.

Great question!  Microneedling and microdermabrasion can be combined and done in the same visit for maximum results!  By doing microdermabrasion prior to numbing the skin you can get better absorption of the numbing agent and achieve the best result needling on freshly exfoliated skin.
However, if you are only able to do one treatment I would advise the microneedling.  Microneedling encourages the skin to make new collagen that will help to even out your texture issues while erasing hyperpigmentation.  
Microdermabrasion is a great treatment for exfoliation and circulation but when dealing with issues of scarring and hyperpigmentation.  I also recommend using a retin-A and Hydroquinone in your home care regimen to create the healthiest environment for cellular regeneration.

I would recommend doing a series of microneedling + PRP treatments to improve the skin and even out the pigment. A series of 3-6 spaced 3-4 weeks apart. Your microdermabrasions can be done to maintain your skin and keep it looking its best! Best to you,