Thank you for your question. You’re looking to improve acne scars and overall skin tone and texture, and you’d like to know if micro-needling with PRP is equal to micro-needling with hyaluronic acid.To give you a bit of information about myself — I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have quite a significant amount of experience with micro-needling, platelet-rich plasma, and hyaluronic acid fillers. I’m also a member of Vampire Facelift® Network of physicians and have been featured in the media as an information resource for PRP and the Vampire Facial® treatment.When asking these types of questions about procedures, it’s important to first go back and identify the core skin issue that needs to be addressed. Acne scars, for example, is a concern that can be treated in different ways with a combination of treatments. To understand acne scarring, you need to think about the inflammation that resulted in acne cysts, which ultimately healed, leaving behind scar tissue, indentations and depressions.Often, acne scars are treated externally by means of a laser or micro-needling. The concept of micro-needling is that you’re creating multiple little openings on the surface of the skin, over which the platelet-rich plasma or hyaluronic acid is applied. You’re asking whether platelet-rich plasma or hyaluronic acid is better when it comes to micro-needling, and in my experience, particularly when dealing with wider or deeper acne scars, PRP is better as far as the perspective of surface application goes. The concentrated wound-healing material in platelet-rich plasma may stimulate more of a collagen response or a healthy skin healing response if you’re applying it from the top in comparison to hyaluronic acid. In my practice, however, we approach acne scar treatment from the inside, rather than the outside. We first do subcision, which is a procedure that releases the scars underneath the skin. We then inject the skin with platelet-rich plasma combined with a hyaluronic acid filler, such as Juvederm or Restylane, to improve volume and stimulate tissue growth in the deeper levels of the skin. This type of approach of rehabilitating acne-scarred skin using platelet-rich plasma in injection form rather in micro-needling form is one that I feel works very well. Other times, I’ll do a combination treatment wherein I’ll do the injection and then perform a HydraFacial®, which is a type of microdermabrasion treatment that makes use of an infusion of glycolic acid and water. This way, the superficial layers of skin are improved without having to make so many penetrating openings in the skin with micro-needling. Micro-needling is a good treatment, but it is one that needs to be used carefully and strategically.Most importantly, keep in mind that acne scar treatment is not a one-time treatment. It involves a long-term, overall treatment plan that allows you to strategize so that you get the most value out of every procedure you have. I hope that was helpful and I wish you the best of luck!