Should I Do subcision, TCA Cross, Halo for my acne scars? (Photos)

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

nothing will get you a cure, but at home peels like cosmelan and enlghten (which we do virtaully see link to emeragecosmetics.com) and dermarolling help build collagen and Improve texture BETWEEN lasers. you can do a much stronger treatment to start then do on going fractora, subcision, bellafill (not sure In these hpotos if TCA cross will help).  halo/profractional can be used as an alternative to co2 but BOTTOM LINE is you need an expert treating you.
Acne scar treatment needs a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif or fractora microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  For those at high risk for hyperpigmentation (darker skin types or asian or hispanic or mixed ethnicities) we already pre-treat the skin with cosmelan or enlighten lightening peels to prevent complications from energy-based or chemical-based treatments.  Best, Dr. Emer.  

The title to my answer is a definite yes from what I can see in the photos provided. Subcision, which I have personally been performing since 1994, is an excellent method for elevating and smoothing indented rolling and boxcar scars. TCA CROSS, which I have been performing for twenty-two years is a proven method for treating ice pick scars, dilated pores and very narrow-based boxcar scars. All of these methods are simple, relatively inexpensive, and have very long record of safety and efficacy--something that cannot be said for the wide array of expensive "in" devices being hawked out there like fraxels, radiofrequency and ultrasound machines. Finally, once the depressed scars have been made more flush with the surrounding skin, professional microneedling, another procedure that I have been using for over two decades, may be used to better blend the color and texture of the treated areas with the surrounding normal skin. Make sure that you vet your doctors well being agreeing to proceed. Best of luck. 

Acne scars are treated differently depending on their appearance and structure. Sometimes there is no actual scar at all, but just a dark spot from inflammation. These spots usually improve on their own if you protect them and keep them out of the sun. In the meantime, to control the inflammation and acne breakouts, topical retin-a cream with intermittent salicylic acid peels can dramatically improve your skin tone and frequency of breakouts. Once the acne is controlled and you continue to do have remaining scars due to permanent dermal injury from acne, a variety of treatments can be performed to remodel the scar from energy-based lasers and radiofrequency devices to mechanical disruption of the scar with microneedling. Deep wide scars can be released and filled in with subcision and a filler such as Bellafill which is specifically designed for divets and depressions left by acne. The very thin or deep ice-pick scars are best treated by excising them completely.  I especially like a combination of a chemical peel for the hyperpigmentation and acne control, microneedling with PRP for texture and collagen building, and PIXEL fractionated laser or RF to resurface and build even more collagen.  I would use the subcision with Bellafill for the individual deeper scars. Not everyone is a candidate for all the treatment options however as certain skin types can get worse from certain treatments. For the best treatment options, it is important to visit an expert for an in-person examination. Hope this helps!
Johnson C. Lee, MD 
Board-Certified Plastic Surgeon

Probably subcision will help, I am not too sure about TCA as your scars do not have sharp edges. RFM , proper ablative lasers (fractional or full) can all help.The ideal treatment for acne scars will depend on the morphology of individual scars. For example, rolling scars are best treated with subcision, atrophic scars with fillers, pick-ice pick scars with TCA or Phenol CROSS/ Paint, box-scar scars with fractional laser/ modified TCA/ phenol chemical peels, hypertrophic scars with steroid injections/modulated fractional delivery. 
Energy devices such as lasers, microneedling RF and bipolar radiofrequency are other methods to treat ‘general’ scar types. For example devices can improve rolling-tethered scars as well as ‘deep - superficial scars’ such as broad ice-pick scars and broad box-car scars. Devices should be viewed as a method of scar revision, and rarely as a sole modality. Exceptions do apply- for example in patients with predominantly shallow/broad box-car scars and or superficial pits. 
Another factor that will determine the ideal combination of treatment is the skin type of patients. Skin typing used to determine the ‘skin colour’ of patients. Darker skin patients will require modifications to treatment parameters. This includes a lower percentage of chemical peels, conservative protocols for lasers and energy devices and in some cases pre and post treatment of skin to reduce but not eliminate the chances of PIH- post inflammatory hyperpigmentation- skin darkening. 
The very first step in scar revision is to accurately determine the subset of scars you have. This is best done with a real time examination. Factors such as animation (rather than static photographs) are frequently used to determine the amount of ‘deep scarring’ /anchored scars or tethering. Palpation or touch is also extremely important to determine the presence of dermal and subdermal fibrosis. Scars that have altered ‘texture’ either hard or soft (atrophy) are more challenging to treat compared to scars with ‘normal’ texture. In some cases the use of angled lighting can be employed to accurately map scar types. 
My answers given in the context of this question is a general plan given the limited information. For an accurate guide, one has to take into consideration factors such as animation, touch, feel, real time examination and most importantly subjective measures, namely patient expectations. A real time consult with a procedural dermatologist or plastic surgeon is required for the best accuracy- diagnosis. 
All the best, Dr Davin S. Lim, Dermatologist. Brisbane. Australia.