46-year-old man, what type of acne scar is it & how I could best treat it? (Photo)

I am sorry that you have not any success with your fractional laser treatments, but I am not surprised. I have been cautioning my followers for many years to exercise a great deal of "buyer beware" caution when being hawked that these kinds of "bells and whistles" devices, since the hard science to back up their use lags well behind the heavy duty marketing hype and social media buzz to promote them.
At least from the photo, the scar appears to be an elongated boxcar-type scar. As such, you would be wise to consult a board certified cosmetic dermatologist acne scar treatment specialist to discuss the use of subcision to elevate and smooth the scar.
Subcision is a technique that I have been using for this purpose with very gratifying results for coming up on thirty years now. Hope this helps and saves you time and money. Best of luck.

Based on your description, it sounds like you may have an ice pick scar, which is a common type of acne scar characterized by its narrow, deep, and pitted appearance. These scars can be challenging to treat, especially if they have not responded well to fractional CO2 laser treatments. Here are some options you might consider discussing with your dermatologist:

Punch Excision or Punch Elevation:
These surgical techniques involve removing the scar tissue and closing the site with stitches or elevating the base of the scar to make it less noticeable.

TCA Cross:
Trichloroacetic acid (TCA) CROSS is a chemical peel technique specifically for ice pick scars. It involves applying a high concentration of TCA directly into the scar to promote collagen production and improve texture.

Subcision:
This procedure involves using a needle to break up the fibrous tissue beneath the scar, which can help lift the scar and improve its appearance.

Microneedling with RF (Radiofrequency):
This combines microneedling with radiofrequency energy to stimulate collagen production and improve the appearance of scars.

Dermal Fillers:
Temporary fillers like hyaluronic acid can be injected to raise the depressed area of the scar, offering immediate but temporary improvement.

Combination Treatments:
Often, a combination of treatments yields the best results. Discuss with your dermatologist a tailored approach that might involve multiple modalities.


Since you've already tried fractional CO2 laser without the desired outcome, it may be beneficial to explore these other options with a dermatologist who specializes in scar treatment. They can provide guidance based on your specific skin type and scar characteristics.

Thank you for your inquiry! Lasers such as Microneedling can be performed to minimize appearance of scars. We would love to see you in person or virtually to discuss treatment options or schedule a consult with a licensed aesthetician to make a plan for you!

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