How bad is my acne scaring and what would be the best procedure to get rid of it? (Photo)

Question

was wondering what will be the best option to get rid of my acne scars, been having it since i was 15 im currently 30 and these are my acne scars as today

Nelson Lee Novick, MD · Answer

From the photo provided, there appear to be the full mix of the most common types of acne scars: boxcar, rolling scars and ice pick scars. There also appears to be some generalized acne-related facial acne atrophy in both the cheeks and temples. 
For the generalized atrophy noted above, a Field Subcision can help to elevate and smooth each area. Remaining individual boxcar and rolling scars that still remain troublesome can then be treated by individual subcisions. Finally  TCA CROSS can be used to treat ice pick scars and dilated pores. 
Both subcisions and TCA CROSS typically requires a series of on average three to four treatment sessions spaced at a minimum of about a six week interval between sessions in order to achieve usually and realistically somewhere between a 60-80 percent overall improvement in appearance. 
You would be wise to exercise a great deal of "buyer beware" when being offered aggressive treatments, such as deep peels, which risks scarring and dyspigmentation,  or a host of expensive "bells and whistles" light and energy-based gizmos, since the hard science to support their use lags well behind the heavy marketing hype and social media buzz to promote them.
You would be wise to consult with an experienced, board certified cosmetic dermatologist scar treatment specialist. Hope this helps and best of luck. .

Anil R. Shah, MD · Answer

Hello, my name is Ranen and I am an aesthetic nurse at Aesthetic skin in Chicago.  That’s a really common and valid question — and at 30, you’re in a good place to finally make progress because your acne is likely calmer and your skin can focus on repair. To give you the most accurate recommendation, it would help if you could upload a clear photo of your scars in natural lighting (front and both sides if possible). That way I can identify whether you’re dealing mostly with: Atrophic scars (ice pick, boxcar, or rolling), Post-inflammatory pigment (dark/red marks), or A mix of both, which is most common.  RF microneedling (e.g., Morpheus8, Secret RF, Genius) → stimulates collagen remodeling in deeper layers. Fractional laser (CO₂ or Er:YAG) → more aggressive resurfacing for texture and depth improvement. TCA CROSS or subcision → if there are defined depressions tethered by fibrous bands. Expected improvement: 40–70% with a series of treatments (usually 3–6 sessions spaced 4–8 weeks apart).

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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