Any suggestions on Microneedling and fillers on acne scars?

Is the outcome of microneedling, specifically with dermapen, worth the cost of several treatments to actually "fill in" atrophic acne scars or do you see better results with fillers? I realize the microneedling takes time and several treatments, whereas a filler produces immediate results but also not permanent. How deep does a scar have to be in order to fill it? Mine are quite shallow and was told it could leave a lump under the skin.

Doctor Answers 4

Best options for acne scar treatments in Los Angeles

Acne scars respond well to microneedling, Ematrix RF, Fraxel laser, and fractional CO2; in addition to chemical peels and laser resurfacing. A combination approach works best, 

DR. Karamanoukian 
Los Angeles

Los Angeles Plastic Surgeon
4.8 out of 5 stars 94 reviews

Treating Acne Scars

Treating acne scars generally requires a combination of treatments to best treat these scars.  I find a combination of injections with Restylane combined with lasers such as eMatrix and Fraxel are best at minimizing these scars.  For the best cosmetic results please see an experienced board certified dermatologist for these treatments.

Michele S. Green, MD
New York Dermatologist
5.0 out of 5 stars 78 reviews

Subcision With Fillers For Raising Depressed Scars; Microneedling For Blending Tone & Texture With The Surrounding Normal Skin

When treating acne scars, a one-size-fits-all approach is not the best way to go. Acne scars differ in size, depth, location and characteristics and treatment of each kind of scar, in order to achieve optimal results, necessitates a tailored approach for each scar.

Generally speaking, however, if a scar is depressed (atrophic, indented), it would be wise to elevate it so that its base becomes level with the surrounding skin. This, by itself, can help to diminish the "craters of the moon" shadowing effect, which, by itself can effect a noticeable improvement in appearance. A series of subcision treatments with or without the concomitant use of a filler has proven in my experience quite useful for this purpose. What's more, since subcision stimulates neocollagenesis and neoelastogenesis (new, native collagen and elastic fiber synthesis), the beneficial results tend to be long-lasting to permanent, as compared to the use of fillers alone whose results are temporary (approximately one year). I don't recommend the use of permanent fillers, such as Bellafill or silicone, as these substances, should there be any complications immediately or even five to twenty years later, cannot be removed from the skin once injected. . 

I have been performing medical microneedling, both manual and automated (e.g. Dermapen)  for over a dozen years and have found it best for improving the surface tone and texture of scars, as opposed to elevating any but the most superficial scarring. The results of this procedure, properly performed in experienced hands (because it, too, stimulates neocollagenesis and neoelastogenes) likewise tend to be long-lasting to permanent.

As an aside, I am less than impressed with treatments such as fraxels and radiofrequency treatments for acne scarring, finding these to be more device manufacturer backed marketing hype than hard science. 

Best to consult with an experienced, board certified aesthetic physician before proceeding. . 

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

A combination treatment is best

Thank you for the question.
For acne scars a combination approach is best. If you have mild to moderate scars, a few treatments with an erbium laser and micro needling with PRP (platelet rich plasma) should get rid of them. It also makes the skin healthier overall.
Good luck.

James R. Gordon, MD, FACS, FAAO
New York Oculoplastic Surgeon
5.0 out of 5 stars 144 reviews

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