Best treatment for moderate rolling acne scars? Have already tried lasers, subcision, microneedling, and fillers. (photo)

Hello, I had cystic acne for years during teens (accutane) & left with moderate rolling scars. About 4 years ago (without doing much research) I mistakenly purchased a 1.5 mm dermaroller for home use, and scarred my skin worse. Since then: 4x fraxel laser, pixel, 5x subcision, professional microneedling, fillers. 30/40% improvement. Seems scars are not tethered down because of subcision-like the epidermis tissue is just very damaged. Does anyone please have advice for another treatment? Thanks!!

Doctor Answers 9

Best treatment for moderate rolling acne scars? Have already tried lasers, subcision, microneedling, and fillers. (photo)

I know this is very frustrating and you have done all the right things but unfortunately the result is still not wear you want to be. The next step I would try would be fat grafting. Fat is becoming very popular for filling the face and other bofy parts. I think you will see some smoothing and benefit from fat grafting to the cheeks. Thank you for the pics and good luck!


Houston Plastic Surgeon
4.4 out of 5 stars 8 reviews

Acne scarring

Thank you for your email. Your rolling scars are best treated FIRST with subcision followed by fractional laser then lastly some long-lasting filler for volumization.

Firas Al-Niaimi, MSc
London Dermatologist
5.0 out of 5 stars 4 reviews

Subcision and Bellafill would be helpful

Thank you for your question and photos! As you know, acne scarring is one of the toughest dermatologic conditions to treat, and often requires a multi-modality approach to achieve results. Based on your photos, I think you would have a nice improvement with subcision underneath the large rolling scars followed by filling with a more long-lasting filler such as Bellafill, which has been FDA-approved for treatment of acne scars. Ultimately, I recommend having an in-person consultation with a board-certified dermatologist or plastic surgeon who is familiar with these procedure and can help guide you to a treatment that is best for you!

I hope this answer is helpful! Best of luck.

Tracy Leong, MD
San Diego Dermatologic Surgeon
4.9 out of 5 stars 7 reviews

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Improving acne scars can be very challenging.  Typically more than one treatment is necessary. With a well planned series of treatments it is often possible to achieve a noticeable improvement.  However, it should also be noted that often it is not possible to completely eliminate the scars.

Considering your history, including your prior treatments, and photographs it is likely that you can achieve further improvement with treatments that include fractional laser resurfacing, erbium laser resurfacing and additional fillers.  Whether these could be used in your treatment would have to be determined at a pretreatment consultation, as every modality is not be suitable for every patient.  The procedures should be performed by a physician who is experienced in using all of these modalities for treatment of acne scars.


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A combination of subcision and injections of Restylane and Bellafill and Sculptra will all improve these deep scars.  it will take time but you need to replace the lost volume to improve the appearance.  Best, Dr. Green

Deep and tethered acne scars

These are too deep to respond to treatment at getting the surface smoother. You need subcision and placement of Bellafill. This will definitely help. It will take 2-3 treatments.

Steven F. Weiner, MD
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Acne scar treatment

All of the treatments you mention can be used for acne scarring. Sometimes filler is a good choice for rolling scars. See someone in your area who has experience in using filler for acne scarring.

Derek Norcom, MD
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Rolling Acne Scars

In my experience these types of rolling scars need to be raised up from below.  Typically I would do subcision and fillers, alone or in combination.  This would likely help more than any resurfacing treatments done on the surface. There are different fillers to choose from.  Please see an expert in the treatment of acne scars.

Regards,

Dr. Ort

Richard Ort, MD
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Your Acne Scar Solution--Fillers, lasers, radiofrequency, microneedling/prp

A combination approach is best: surgery, subcision, fillers like Bellafill, Sculptra, Radiesse for "rolling" scars with lasers such as co2 laser resurfacing or Fraxel/Clear+Brilliant or radiofrequency such as Sublative or Viva to improve the scars and give long term collagen production and microneedling/prp to improve texture and tone. I recommend seeing an acne scarring expert. Best, Dr. Emer 

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These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.