Best options for acne scar treatment? (Photo)

Hi. You have been on the right track but possibly on the wrong horse. There are 2 parts to the answer: #1 Laser- only a fraxelated laser will work: industry leader/standard is Fraxel- other types can t go deep enough safely. #2 Bellafiill - like silicone it stimulates collagen ( to elevate ) but unlike silicone : it produces some immediate fill also & will not migrate ( I use Silicone 1000 only in the lips where it can t migrate ). Douglas Hamilton,M.D. Los Angeles,Ca.

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

this is improved with subcison and filler + lasers and/or microneelding RF like pixel8 or fractora. start dermarolling at home now (see link).

at home peels like cosmelan, enlighten and aerify along with dermarolling (Emerageskin roller with anteage MD AERIFY ampules weekly) should be started now (see link to emeragecosmetics).

if you have post inflammatory hyperpigmentation/melasma/discoloration that needs cosmelan or enlighten peels at home which we can do virtually and send to your home along with aerify peels regularly, vivatia foam, restorsea 10x, faith essence serum, and cosmelan 2 cream.

Acne scar treatment needs 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, halo, maxi, pro fractional laser/erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora 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.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer. 

First, let me say that I am not surprised by the lack of success with the laser treatments, as I have been cautioning readers of RealSelf for years already that the science to support relatively expensive "bells and whistles" lasers (and other so-called energy-based treatments, for that matter) lags well behind the intense marketing hype to promote them. I have likewise cautioned readers against the use of permanent fillers, such as silicone and Bellafil, since permanent fillers can translate down the road into permanent filler complications that can be provoked by manipulation of the injected areas--not just immediately, but even five, ten or twenty+ years later. So, this segues to the problem here. Ordinarily, I would suggest subcision as the treatment of choice for tightly-bound down, tethered boxcar scars. However, my concern here is that since these areas have already been injected with silicone, the very manipulation of the skin by a subcision could in fact become a trigger for the development of difficult-to-treat lumps and granulomas. I suggest you consult with a board certified cosmetic dermatologist with extensive experience in performing subcisions and one who also has experience in treating the complications of permanent fillers. Perhaps he/she will opt to try one scar first as a test to determine your particular response to treatment before going ahead and treating all potential sites . Wishing you the best of luck.

A series of micro-needling treatments with PRP, plasma rich platelets, would probably be very helpful. I would suggest finding a medical spa and discussing your concerns.

I'd think about subcision with hyaluronic acid fillers, as well as microneedling (by itself, or better yet with PRP, or even better yet with RF). Stubborn scars might be punch excised. Deeper chemical peels like TCA can also help. Not clear which "laser" you had - you might have had only non-ablative laser, whereas you might benefit from an ablative laser (e.g. ProFractional). No easy answer, and multiple treatments will be needed. Best to chat with your local dermatologist for optimal guidance, treatment results & safety.

I would use your fat and refine the components that we need out of it to help the quality of the scar and also to treat the depressions created as a result of the scarring process itself. This can be done as a day case procedure and would take about an hour to hour and a half to do.