What would you recommend for my post acne scars and texture? (Photo)

Question

Hello, what would you recommend for these post acne scars/ spots and the wrinkles on the face ? Have tried fillers, laser genesis and Botox. Some RF in the past.

Nelson Lee Novick, MD · Answer

Frankly I am not particularly surprised by the lack of success with the lack of success with the laser and RF bells and whistle treatments.. I have been cautioning my regular followers for years that the hard science to support the use of these relatively expensive gizmo treatments lags woefully behind the heavy marketing hype and social media buzz to promote them. Sorry. Likewise Botox and fillers would have been unlikely to have done much. So, no surprises there, either.
That being said, there are some tried and true techniques that have stood the test of decades of time for safety and efficacy in all skin types. This includes subcision, which I have been performing for all kinds of indented boxcar and rolling scars from acne and professionally performed manual miicroneedling (no need for the added expense and risks of RF microneedling) for helping to blend better any residual surface, superficial texture and color irregularities with the surrounding normal skin. You would be wise to consult with a board certified cosmetic dermatologist. 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

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

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