Is there any point having Sciton Profractional, then going over deeper scars with Fractional CO2? Is TCA a good idea? (photos)

I have mod-severe mixed type scarring on one temple and mild rolling scars over cheek and forehead. I've been advised to have Sciton Profractional to level out the entire face, then have Ultrapulse CO2 for the deeper scars. Is this just wasting time and money? Wouldn't going straight to the Ultrapulse be better? I was also told that TCA would be a bad idea but this was at a laser clinic so I don't trust that. Any help is very appreciated!

Doctor Answers 2

The Most Effective Way To Treat Acne Scars Is With A Combination (Multi-Modality) Approach

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As is usually case, your photo demonstrates a mix of acne scars, including rolling scars, deep boxcar scars and ice pick (pit) scar. There is also some generalized temple, forehead and cheek volume loss.  Accordingly, a combination of techniques, i.e. a multi-modality approach, rather than "A One Size Fits All" approach is best for treating your acne scars. To address the volume loss, I would first begin by volumizing the area beneath it with a volumizing filler, which by itself can help to elevate and stretch the overlying scars. For this purpose,  in my Upper East Side Manhattan office, I would opt for Voluma XC, while in my Israel satellite facility, where a far greater number of regulatory agency approved volumizers are commercially available, I would opt for Stylage XXL.  Atrophic (indented scars), i.e. the rolling and boxcar types, can be treated with subcision to raise them up with or without the addition of a lifting filler, both for its immediate lifting and for its biostimulatory effect (to promote new, native collagen and elastic fiber synthesis). My choice would be Restylane Lyft (NY) and Hyaluronica 2 (Israel). Pits and very dilated pores may be treated with The TCA CROSS Technique, using either full strength TCA or phenol; rolling and boxcar scars may be improved with subcision followed by microneedling. Tiny droplets of Botox may be placed in a grid fashion throughout the pitted area to achieve additional improvement. I have not been impressed with expensive fraxels, radiofrequency or ultrasound devices, which are proving themselves to be backed far more by device manufacturer supported marketing hype than hard science. So, your skepticism about the advice of the laser clinic people may be well founded. Please note, that unfortunately, mature scars from any cause, including those from acne, cannot be completely eliminated. However, they can be improved signficantly in appearance. For more information on any of the above, you may check out the archives of and be certain to consult wtih a board certified aesthetic physician with experience and expertise in treating acne scars. And continue to be cautious about places interested in hawking some relatively expensive one-size-fits-all,  "next best thing" device to come along. Hope this helps. Good luck


New York Dermatologic Surgeon
4.9 out of 5 stars 33 reviews

Getting the Most for Your Money

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This type of scarring would do best with a combination approach. TCA cross is good for deep or pitted "ice pick" scars while fillers like Bellafill, Sculptra or Radiesse  are good for "rolling" scars. The Eclipse Micropen is good for all types of scars and improves texture and tone. Also, lasers such as co2 laser resurfacing or Fraxel/Clear+Brilliant along with radiofrequency treatments (Viva) can also help improve the scars and give long term collagen production. See an expert. Best, Dr. Emer

Jason Emer, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 204 reviews

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.