What is the best procedure for my acne and acne scars? (Photo)

Question

I have taken 5 session of vivace and already taken 2 session of fractional CO2 and recent taken fractional CO2 but no improvement which procedure is best for me kindly guide me

Nelson Lee Novick, MD · Answer

I have written about this many, many times, as all my regular followers would tell you. I am sorry that you have spent your time and money for nothing for the expensive "bells and whistles" energy-based treatments. The hard science to support their use lags woefully behind the heavy marketing hype and social media buzz to hawk them. So, no surprises with your lack of success 
For large swathes of acne scar-related atrophy, for example of the cheeks and temples, consider Field Subcision to elevate and smooth the overlying skin and make those overlying scars more shallow. For individual boxcar and rolling scars, individual subcisions can be helpful for further elevation and smoothing. For ice pick scars and dilated pores, consider TCA CROSS. Both subcision and TCA CROSS have been used for decades and have proven safety and efficacy in all skin types. You would be wise to consult with a board certified cosmetic dermatologist scar specialist before wasting time and money on the next, unproven, expensive, here-today-gone-tomorrow gizmo device. Hope this helps.

Anna Chacon, MD, FAAD · Answer

Hi,

Thank you for sharing your photo and details—it really helps to tailor advice. For active acne and the scarring that can follow, the best approach often combines treatments for both the current breakouts and the texture changes left behind.

For active acne:

Topical treatments like retinoids (tretinoin, adapalene) help regulate skin turnover and prevent clogged pores.

Oral medications may be appropriate depending on severity, including antibiotics, hormonal options, or isotretinoin.

Procedural options such as chemical peels or light/laser therapy can reduce inflammation and improve overall skin clarity.

For acne scars:

Microneedling stimulates collagen and can improve shallow rolling scars.

Fractional CO₂ or erbium lasers can resurface the skin and help with deeper scars and texture irregularities.

Subcision may be useful for tethered or depressed scars.

Combination approaches (laser + microneedling + topical treatments) often provide the best results, especially for mixed scar types.

It’s important to treat active acne first before focusing on scar remodeling, as new breakouts can worsen scarring and interfere with healing. Patience and a stepwise plan often yield the most natural and lasting results.

Raffy Karamanoukian, MD, FACS - Account Suspended · Answer

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing.
 
As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.
If you have ice-pick scars, we recommend RF ablation and TCA Cross.
Best,
Dr. Karamanoukian
Realself100 Surgeon

What is the best procedure for my acne and acne scars? (Photo)

Answers (3)

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