What scar treatments should I pursue? CO2, Fraxel laser? (Photo)

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Unfortunately,. most of the expensive "bells and whistles" gizmos out there, like fraxel lasers, RF devices, etc. have woefully little hard science to back up their uses and a whole lot of marketing hype and social media buzz. For acne scar treatment, you might wish to explore treatments that each have decades' long track records for safety and efficacy in all skin types. These include Field Subcision to restore the volume to the cheeks (the sunken cheeks) lost by acne-scar related atrophy; individual subcisions for elevating and smoothing boxcar and rolling scars; TCA CROSS for ice pick scars and dilated pores; and manual microneedling (no need for the added expense and risks of RF microneedling) as a final step to help blend better the treated areas with the surrounding normal skin. And when I say Field Subcision I am not referring to a very aggressive form of subcision treatment that is quite common there in Utah. So before spending a whole lot of hard earned money and dealing with a whole lot of disappointment, you might wish to consult with an experienced, board certified cosmetic dermatologist acne scar specialist and not just any venue hawking their latest expensive device purchase. And an additional word to the wise: Don't go in to any place asking for a specific treatment because, to your later monetary and emotional chagrin, you may very well get it. Hope this helps and best of luck.

Boxcar and saucer-shaped scars are types of acne scars that can be challenging to treat. Treatment options depend on the severity of the scars and may include:

1. **Laser therapy:** Various types of lasers, such as fractional laser therapy or CO2 lasers, can help improve the appearance of acne scars by stimulating collagen production and resurfacing the skin. However, lasers don't lift scars, they smooth them. The Co2 and Fraxel work similarly and both would not be necessary.

2. **Microneedling:** This procedure involves using a device with fine needles to create tiny punctures in the skin, stimulating collagen production and helping to improve the appearance of scars. Radio-frequency microneedling is more effective and can raise scars more efficiently.

3. **Dermal fillers:** Injecting dermal fillers, such as hyaluronic acid, into acne scars can help fill in depressed areas and improve their appearance temporarily. In your case it can work on individual scars and your depressed contour.

4. **Subcision:** This procedure involves using a needle to break up scar tissue beneath the skin, allowing the skin to lift and smooth out. Use of a Cannula as well as a Nokor needle is suggested.

It's important to consult with a expert dermatologist to determine the most appropriate treatment plan based on your individual needs and the severity of your scars. Additionally, it's essential to have realistic expectations, as acne scar treatment often requires multiple sessions and may not completely eliminate the scars.

Jeff Rapaport MD FAAD
Realself Hall of Fame
Castle Connolly Top Doctor

Hello; you have deep acne scars on your face. The golden standard for acne scar treatment is "fractional carbon dioxide laser". You should get fractional carbon dioxide laser. Fraxel would not be the right choice; because, Fraxel is a sort of laser; which is used primarily for pigmentation. Fractional carbon dioxide laser renews your skin, vaporizes it and since it has a wavelength of 10,600 nm, it penetrates into the deeper layers of the skin and stimulates the skin for new collagen synthesis. TCA peeling treatment would be an extremely wrong selection. Do not get it done. Because, peelings were used long ago before lasers and they are not reliable treatments; since they deepen uncontrollably. With TCA peeling, even unwanted scars may stay. It has no place in acne scar treatment. By the affects of fractional carbon dioxide laser, you will see that; your skin becomes tighter, your pores close and you look much younger; more vigorous. If it is necessary for adding that; to eliminate acne scars, fractional carbon dioxide laser also has a skin tightening effect. Therefore, it is considered among the non-surgical face lift treatments.