Would subcision and Bellafill + TCA CROSS be a good treatment for my acne scars? (Photo)

Question

So far I’ve a Pearl ablative laser treatment, Sciton profractional laser and most recently 3 treatments of Infini RF. I had the Infini treatments from July 2018-September 2018. I feel like my scars appear a little softer but I’m not super impressed with the results. I was wondering if getting subcision and Bellafill would possibly be a good option for me? When I smile or emote my skin pulls down where my scars are and creates lines..i was wondering if this means my scars are tethered?

Jeff Rapaport, MD · Answer

In  my opinion, you have tethered scars as well as a loss of support structure. TCA can be utilized on the narrow small scars. The tethered scars can be treated with subcision plus PRP. I prefer to perform fillers after the results are matured. Furthermore, another reason that your skin gathers with movement is the loss of support structure. This contour defect can be corrected with fillers or fat. Find a scar expert. Good luck.
Jeff Rapaport MD
Realself All-star

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Jason Emer, MD · Answer

Thank you for your question!  Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.- Subcision for depressed, tethered scars.- Vascular lasers like Yellow laser, Aerolase, excel V, or IPL for redness or thick acne scars.- Lasers such as Fraxel, Erbium, CO2 or fractional radiofrequency (Venus Viva, Skinfinity, Intensif microneedling RF) for textural issues and superficial scarring.- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.- Medical-grade skincare, which can be found at Emeragecosmetics.com, can also enhance results.  (See link below)
All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer.

Steven F. Weiner, MD · Answer

I am a fan of Infini (which has recently been re-engineered and is called Genius) but scars often need multiple approaches to improve. In your case I would subcision and filler. I don't think TCA is needed but I would determine that at the time. PRP might add some benefit as well. We have also used AmnioDry in patients after Genius with success.

Davin Lim, MBBS, FACD - Account Suspended · Answer

Agree with Dr Rapaport and Dr Weiner- the MOST effective treatment is manual subcision with buffer HA filler. Thanks for providing great photos on animation - something that 99% of patients DO NOT provide. Those photos tell the true story of what is going on UNDER your skin. Field subcision under a nerve block is the treatment of choice, aided by devices like RF, lasers etc.. small narrow scars, IF present can easily and effectively be treated with TCA CROSS. All the best, Dr Davin S. Lim. Brisbane. AU.

Would subcision and Bellafill + TCA CROSS be a good treatment for my acne scars? (Photo)

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