Dermabrasion or peel to improve smooth skin texture when your skin is dull, wrinkly, rough and acne scarred? (Photo)

Question

Photos below: One photo is how my skin looks. The second photo is photoshopped how I want my skin to look. My skin is wrinkly, loose, dull, rough, jagged, uneven, and I have tons of small acne scars that look like chicken pox scars. Fraxel laser made my face worse because my skin is so thin. Which treatment is best to improve my skin texture? Dermabrasion, micro-needling, chemical peel, TCA peel? I really can't afford tightening or facelift. And Dermal fillers aren't right for me. Advice?

Raffy Karamanoukian, MD, FACS · Answer

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

Mira Mahajan, MD · Answer

Hello moocow19812003,
Thank you for your question from looking at your photos best treatment for you would be a Deep Resurfacing laser treatment in combination of subcision of the scars. Your likely going to need a couple sessions of treatments to achieve the results you desire. Bellafill is also a great why of filling in the scars. Bellafill last up to 5 years. Find a specialist near you to help you achieve the skin texture you want. Good luck!

Davin Lim, MBBS, FACD - Account Suspended · Answer

The deepest scars are ice pick scars. This is the RATE LIMITING SCAR. I would perform 2-3 TCA CROSS at 100% TCA application, once raised up, you do have a choice of lasers, peels or mechanical dermabrasion. Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

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