What is the best option for treating nodular and cystic acne scars? (photos)

Question

Hi, I’m late twenties and struggle with nodular and cystic acne, as well as closed comedones. I have mild HS I’m working again to get this under control after pregnancy and breastfeeding. Once active acne has improved, what is the best treatment for my specific scarring? I have small pitted scars, one that is hypertrophic and pitted in the middle, and a deep rolling scar on my cheek that makes that side of my face seem more down turned. Is laser, micro needling, subcision, or combo the best?

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

Here's a post-Christmas gift to you that will likely save you a whole lot of money, time and needless frustration. In your search to find the best treatments for your acne scars.  For one thing, you will likely be barraged by every venue to undergo relatively expensive fancy-named fraxel laser and/or RF treatments. Keep in mind that these "hear-today-gone-tomorrow" supposedly "next big thing" bells and whistles gizmos are backed far more by heavy marketing hype and social media buzz, but unfortunately very little hard science. On the other hand, there are several relatively simple techniques that have stood the test of time for efficacy and safety for improving acne scars in all skin types. Subcision, which I have been regularly using since 1995 works well for elevating and smoothing acne boxcar and rolling scars. TCA CROSS, which I have been performing for 24 years for ice pick scars and dilated pores, is another simple and inexpensive treatment with proven efficacy and safety in all skin types. And finally, professionally performed manual microneedling (no need for the added expense and risks of RF microneedling) --another simple approach that has demonstrated nearly a quarter of a century of efficacy and safety for improving ovarall superficial texture and color of the skin--can be used to better blend the color and texture of the treated areas with the surrounding normal skin. You would be wise to seek consultation and treatment by an experienced board certified cosmetic dermatologist acne scar expert and be wary of the device hawking and hype out there. Best of luck and Happy New Year.

What is the best option for treating nodular and cystic acne scars? (photos)

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What is the best option for treating nodular and cystic acne scars? (photos)

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Everything you need to know about ProFractional Laser

Our mission is to create a world where every investment in modern beauty is Worth It.