Which system is best for early jowls and old acne scars for lower face? So many different ones to choose from (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

The photo provided reveals evidence of lower face volume deficit. Since the cheeks provide lift to the lower face, performing a Field Subcision of the midface along with revolumzing the midface with an appropriately robust HA volumizing filler can not only contour a more feminine, heart-shaped oval face and elevate and smooth the overlying acne scars, but can provide sufficient lift to elevate and soften the smile lines below and even to some (usually more limited) extent to straighten incipient marionette lines to the sides of mouth. The results of Field Subcision accompanied by the use of an appropriately robust HA filler, vis-a-vis the early jowling, in experienced hands, should take no more than about fifteen minutes to perform, are immediate, typically evoke a "Wow! response, and engender little to no significant downtime.
Professionally performed manual microneedling (no need for the added expense and risks of RF Microneedling), which I have been routinely performing for nearly a quarter of a century, is best reserved for treating very superficial, skin surface texture and color irregularities and is not particularly good as a monotherapy for treating deeper scars.
Be very wary when being hawked expensive light and energy-based gizmo treatments (no matter how alluring or fancy their names sound), as the hard science to support their use unfortunately lags well behind the heavy marketing hype and social media buzz to promote them. "Buyer beware" when it comes to these is sound advice.
And one final word of caution, don't go into any consultation asking for a particular treatment that you may have seen promoted by unreliable social media sources and so-called skinfluencers, since, to your later frustration, disappointment and financial loss, you are very likely to get what you ask for. Hope this helps and best of luck.