Rolling Acne Scars on Right Cheek, Would Subcision Work? (photo)

  I recommend a multimodality approach.  I would consider punch excision, subcision with fillers, and facial resurfacing for best results.

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

"​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. ​"

The rolling atrophic scars will respond to subcision but also need filler for optimal correction. The scars are hard to see with the current pics. Other treatments include PRP, RFM which will give additional benefits.

Dear grace,

Thank you for your question. 

Acne scars are common, but with advancement in technology, thankfully it is not something you have to live with.

Acne scars are the result of the breakdown of collagen and elastin in your dermis. They frequently occur at sites which were acne prone in the past, namely your temples, cheeks etc.

Acne scars are 3 dimensional, hence submitting a photo will not do justice to your scar. It requires real time examination (touch and animation), combined with lighting from various angles. That is why you may notice your scars differently in the bathroom mirror and in the dressing table mirror.

Dr Daniel Chang’s 3 STEP ACNE SCAR Treatment Formula: 

1- Control acne

2- Treatment – Fractional laser + skinboosters ( to promote collagen growth)

3- Maintainence with lasers ( to optimise collagen stimulation)

STEP 1: CONTROL YOUR ACNE. (Refer to this page on acne for more information)

Achieving good control of your acne is the important principle towards helping your acne prone skin. This prevents new scars from forming, which is a big step forward. Dont be too worried about your existing acne scars. Focus on prevention first.

STEP 2: Treatment based on scar type. Below are the 4 main types.of atrophic scars.

Ice pick scars =>    can be treated with TCA CROSS, Fractional and Microneedling

Rolling and box scars scars => are best treated with a combination of  RF Microneedling, PRP, fractional lasers and subcision

Hypertrophic scars can be treated with

 Microbotox
Intralesional steroid

Atrophic scars -> A combination approach is what I would recommend to improve the appearance of such scars.

Laser Resurfacing +/- RF microneedling 
Subcision
Dermal fillers – Skinboosters – Please refer to my Page on Skinboosters 
Intralesional saline – ( Latest evidence from Journal of Dermatology Sept 2016)

Fractional C02 used to be the industry gold standard for treatment of acne scars. Current studies point towards combination therapy, as I have outlined above. In addition, As collagen takes 3 months to grow, multicentre studies show one would require at least 4 sessions to see results. 1 session is unfortunately not enough.

New technology includes air dissection. Being a new treatment, I do not know of any randomised controlled trials regarding its safety and efficacy at present. Most studies are anecdotal. So time will tell.

You have atrophic scars that have responded to treatments before, so the combination approach above would help you.

I hope you find this helpful.

Hi,Laser treatments do take 3- 6 sessions to get better results, but adding on subcision / dermabrasion/ platelet rich plasma - these are all options to improve the  outcome.

I would treat your rolling scars with some type of filling and laser resurfacing. Your scars are not that bad as I have seen so being conservative would be important.

It is difficult to assess from the pictures which are blurry, but rolling scars tend to do very well with injectable fillers. In our practice we use liquid injectable silicone, which is a permanent filler (used off-label).  It is excellent for acne scarring because of its permanence as well as its precision.  Regarding the pitted scars, I personally think fractionated laser is a lot of hype (and temporary swelling!0. There are other treatments that give better results and cost less such as punch excision, subcision and light electrodessication.  Most importantly, you should consult with a board-certified dermatologist experienced in treating acne scars. 

 

 

In our practice and I’m sure every practice has their own way of treating acne scars. We have laser treatments and or a mini facelift to stretch out the skin. We have Profractional laser treatment and micro laser peels. Those procedures will improve your acne scars dramatically. If you want the least invasive and no down time with mild correction a Vipeel can help with that as well.

 

 If you can stretch your skin and see the rolling scars disappear, then they will respond well to fillers. Total FX can improve these scars by both tightening the skin and by producing collagen beneath the depressed areas. Acne scarring is difficult to treat. I think that 30% improvement is about what I would expect although this varies significantly according to laser settings.

 If the pits are "ice pick" type scars, they will need to be punch excised prior to laser. If the pits are more shallow and broad based, my experience is that they do very well with fractionated CO2 resurfacing.

 Hope this helps.