Cool Peel with RF Microneedling OR HALO Laser - advice? (photos)

Question

I am a 35 year old South Asian female. I have atrophic scarring on cheeks and some light PIH. The atrophic scarring is rolling, boxcar scars. Since 2019, I had 3 microneedling sessions w/ PRP, 9 Clear and Brilliant sessions and 1 HALO laser. C&B is not invasive enough. I saw some improvement after the first microneedling session w/ PRP and little improvement with HALO laser. Should I do another HALO or instead opt for Cool Peel w/ RF Microroneedling treatments? Haven't tried Cool Peel or RF.

Nelson Lee Novick, MD · Answer

I have taken great pains over the past few years to alert RealSelf readers that the hard science to support the use of the relatively expensive "bells and whistles, " supposedly "next big thing" fad fraxel lasers, RF devices, PRP, etc. lags well behind the heavy marketing and advertising hype that surrounds them. So, there is little surprise about the marginal improvement seen so far. Subcision, for elevating and smoothing rolling and boxcar scars, has a proven track record of safety and efficacy in all skin types of nearly thirty years (I personally have been performing subcisions since 1994). Likewise, TCA CROSS, for treating ice pick scars and dilated pores has over two decades of proven safety and efficacy in all skin types. It would seem prudent, especially at this point, to seek consultation with a board certified cosmetic dermatologist to explore these established options rather than placing jumping from one fad to another.  Hope this helps.

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

Cool Peel with RF Microneedling OR HALO Laser - advice? (photos)

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