Was recommended subcision + Fractora. Thoughts? (Photo)

Question

Hello, I had a consultation with a reputed dermatologist clinic for my acne scars. I was told my scarring is mild to moderate. I went in knowing about subcision, which she said can help but really pushed Fractora. We decided on subcision without filler since she said she doesn’t think I need the filler, plus 3 rounds of Fractora, with the first the same day as my subcision. Is this a good plan? Also, I had read that subcision doesn’t work well without fillers. What do you think?

Nelson Lee Novick, MD · Answer

I have been performing subcision since 1995 and have literally performed tens of thousands of subcisions. Individual subcisions are best reserved for elevating and smoothing boxcar and rolling scars. It simply does not work well for ice pick scars or dilated pores.  A Field Subcision, however, of the entire cheek areas may help. That being said,. since the predominant issues seen in the photos are dilated pores and ice pick scars, TCA CROSS,  which I have been performing for twenty-three+ years, and which can be safely and effectively performed in all skin types, would be the more appropriate approach. As to the fraxel lasers, I have been cautioning my regular followers for years to exercise a very healthy dose of buyer beware when considering these expensive "bells and whistles," as the hard science to support their use lags woefully behind the heavy marketing and social media hype to promote them. However, by the time of this writing, unfortunately, you may already be experiencing buyer's remorse from these treatments. Sorry. Going forward, you would be wise to consult an experienced, board certified cosmetic dermatologist acne scar specialist. Best of luck.

Raffy Karamanoukian, MD, FACS · Answer

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 HIDEF 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 been 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 laser 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.

Subcision works well alone and in combination with other laser and RF platforms, including fillers and air subcision. TCA Cross can be combined with subcision. 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

Harold J. Kaplan, MD · Answer

Hello Haris.  We believe that the best starting point for your situation is TCA Cross.  This is an acid solution that is placed into each tiny spot.  Your ice pick scars are small enough that they would respond extremely well to TCA.  Once the TCA fills in those tiny holes, it would be more appropriate to take on a laser resurfacing program for remaining textural issues.

Was recommended subcision + Fractora. Thoughts? (Photo)

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Was recommended subcision + Fractora. Thoughts? (Photo)

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