Subcision without filler? (Photo)

Question

I saw Dr Calkin in Sacramento for a consult on how best to improve the cystic acne scarring around my mouth. There is a large dent on either side of my mouth (pictured). She suggested subcision with or without filler. I opted for without filler, but now am second guessing myself. Do you think I will see improvement with just subcision? To clarify, I do not expect anything to 100% "fix" my scars so my skin is perfect. I would be happy with modest improvement.

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

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,As the panel members suggested, the best treatment plan for your condition involves more than one option.  In our experience, using deep fractionated lasers that reach to the level of scarring works best to remove scar tissue, and create an environment for new, healthy skin/tissue/collagen to replace it.  Based upon the depth of the scarring, having a smooth gel filler after a laser treatment will help soften the area and create a more smooth topography of the skin.  Please see the below link for before/after photos for the Sciton ProFractional laser.  Additionally, we have before/after photos of subcision with gel filler for acne scarring in our photo gallery.

Jason Emer, MD · Answer

A combination approach will give the most improvement. This type of scars need a combination of subcision and fillers with lasers and microneedling/prp. It may take a series of treatments and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Daniel Barrett, MD · Answer

Dear Monique7683,I would certainly have to examine you but in general, treating acne and the scars takes a comprehensive approach.There are a variety of ways to treat the scars .  A good first step is to get on a skin care regiment that normalizes and conditions your skin such as ZO Skin Health.  The next step that is relatively inexpensive is a peel or series of peels.The next step up would be laser resurfacing such as fraxel. Even with laser, some of the "ice-pick" scars still subsist and remain. I've found in my practice that local subscision, using a needle to elevate the scar followed by fat grafting gives the best results for these deeper acne scarsDaniel Barrett, MD, MHA, MS 
Certified, American Board of Plastic Surgery  
Member, Am. Society of Plastic Surgery

Hratch Karamanoukian, MD, FACS · Answer

I recommend that you see an expert who can provide different treatments or combination therapy for your acne scars.I recommend Dr Raffy in Santa Monica, CABest

Davin Lim, MBBS, FACD - Account Suspended · Answer

In any case multiple treatments are needed. The original papers on subcision suggested 3-6 treatments for moderate scars. So this option is totally acceptable. Filler can act as a buffer and you may receive more improvement with this procedure. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
  
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars. 
  
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best, 
  
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

Subcision without filler? (Photo)

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