Recommendations for acne scar treatment? (Photo)

Question

Hi, I'm a 24 male with acne scars and mild rosacea. I'm guessing I have mostly boxcar and rolling scars. Unsure how severe my scarring is so any input would be appreciated. I'm on 10mg of Oratane(isotretinoin) and my dermatologist advised me to undergo BBL and PicoCare laser to tackle my rosacea and acne scars. Q1. How many treatments do I have to undergo to see improvement? Q2. Should I consider other acne scars treatments that are more effective/cost efficient for me?

Nelson Lee Novick, MD · Answer

Of course, there is no substitute for an in-person examination, but at least from the photos provided, there appears to be some conventional acne pustules, some acne papules and considerable post-inflammatory erythema (redness) and the suggestion of many areas, particularly over the cheekbone of perhaps very superfiical rolling scars. Frankly, I don't really see rosacea--at least not in the photos.  As a general rule, it is best to suppress the acne fully before addressing any acne scars, since new breakouts can rinterfere with any progress made in treating the scars, just as the original breakouts scarred normal skin. Once the acne is controlled for a while, you may be surprised that much of the erythema would fade on its own and many of the more superficial scars would become so much less obvious and bothersome. If necessary, any existing rolling or boxcar scars can be treated simply and inexpensively by subcision to elevate and smooth them. Subcision is an inexpensive technique that has stood the test of decades of time for safety and efficacy for elevating and smoothing both boxcar and rolling scars in all skin types.  The use of relatively expensive lasers and other so-called light and energy-based devices is unfortunately backed far more by marketing and social media hype than any hard science. So, exercise a healthy dose of "buyer beware" when considering these.  You would be wise to consult a board certified cosmetic dermatologist who can help both with the active acne treatment and with the subsequent acne scar treatments. Hope this helps and best of luck.

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Jason Emer, MD · Answer

"​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. ​"

Recommendations for acne scar treatment? (Photo)

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Recommendations for acne scar treatment? (Photo)

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