Always suffered with acne scars. Did CO2 resurfacing in 1998. Big breakout for a year after that. Cleard up with Accutane. Did Fraxel Restore in 2018, and have done 5 microneedling sessions since. Texture and stubborn rolling scars are my continuing problem. Just discovered subcision and TCA Cross. Thinking they might help further improvement. Please let me know what you think.
June 19, 2020
Answer: Acne scars 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
Helpful
June 19, 2020
Answer: Acne scars 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
Helpful
July 5, 2020
Answer: Scars and treatments 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.
Helpful
July 5, 2020
Answer: Scars and treatments 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.
Helpful