What treatment would give the best result for my acne scars? (Photos)

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 acne 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

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.
- Subcision for depressed, tethered scars.
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring.
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Hello, 
I think subcision for the deeper scarring to start followed by a series of ResurFX treatments (3-6) would be a reasonable option for treatment for the scars you currently have. I would seek out a professional that has a wealth of experience in treating acne scarring. 

Laser resurfacing, skin care and at times direct excision are the best treatment options for improving acne scarring.  A plastic surgeon should come up with a thorough and comprehensive skin care regiment to treat the individual patient.  

Hello Ksoni08,
Thank you for your question and the photos. The treatment that was recommended to you (Microneedling and ResurFX) are both great treatment options. Keep in mind that you will most likely need at least 3-4 treatments with the ResurFX. You may see the best results from one or two treatments of CO2 laser resurfacing. Hope this helps!

I would recommend starting with a series of TCA CROSS treatments and then deciding on additional treatments after that.  I would seek out a doctor who specializes in treatment of acne scars with many different treatment options depending on type of scar, skin type, etc.  Best,Dr. Ort

This is not a complex job, but a LONG one. This is based upon the severity (surface area of scarring), and your skin type. Treatments include TCA CROSS, paint as well as energy devices and surgical subcision. One good treatment will improve things by 25%, ideally 4-8 sessions based upon your expectations. Time frame is 8-18 months. PIH Is universal.Scientific papers in 2019 has shown that PRP improves healing time and is associated with greater patient satisfaction rate. There are conflicting studies on the end results. In one paper ablative fractional laser gave superior results compared to microneedling alone, another paper in 2018 showed improved END results with simple needling, combined with PRP compared to needling alone. PRP is most effective in the management of atrophic scars. 
Here are some unbiased points regarding PRP 1. This should be combined with other treatments including laser and or microneedling/ RadioFrequency.2. PRP by itself has little efficacy. 3. PRP best used for atrophic scars. 4. Scars such as box car scars, tethered, rolling and ice pick do not respond well to PRP. 4. Without doubt PRP speeds up healing 5. PRP is only good as adjunctive treatment 6. PRP is HIGHLY dependent on the skill sets of your plastic or dermatological surgeon, as manual subcision is frequently required for the management of associated dermal / subdermal fibrosis. 7. The rules of treating acne scars based upon their merits still applies- see below for more understanding. 
Acne scar revision comprises of many specialised procedures. For the best results, one should target the acne scar type with appropriate treatments METHODS. Using one or two devices is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one. Remember, scar revision is a medical procedure that is technical to perform. It is not dependent on the clinic, branch, machine, or laser but by the skill of your dermatologist of plastic surgeon. 
Take for example deep ice pick scars, and narrow box car scars. These are best treated with TCA CROSS and focused angled CO2 fractional laser in low density. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat graft, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 
In the vast majority of patients, different patterns of acne scars will be present. Monomorphic acne scarring (scars of the safe subtype) are extremely rare. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combinations that yields the best results. It is never about the device, it is about the specialist behind the equipment that will deliver the best outcomes. 
Global leaders in acne scar revision will always use manual methods to revise scars, and employ lasers and energy devices as instruments to assist. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.