Acne scar treatment - subcision with filler? (photos)

Question

Hi Asian guy here, 30 years old. I've been struggling with acne scar for a long time. Tried Fraxel laser and subcision, nothing seem to work. Would really appreciate any suggestions. I'm thinking about doing another subcision with filler, but nothing if that is going to help.

Jason Emer, MD · Answer

Yes, these types of scars need a combination approach to get improvement with subcision, filler with lasers and microneedling/prp. It may take a series of treatments to get improvement and may need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Raffy Karamanoukian, MD, FACS · Answer

Acne scar treatments fall into three categories: 
Pigmentation:
 Dark acne scars can be improved with the Kareskin Brightening Kit with 
Melarase creams; Covalent peels, and Melapads daily exfoliation.
Redness: PIE erythema is best treated with RF and pulsed dye laser.
Contour indentations: Treatments with subcision, fractional laser, PRP SC, and fillers.
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Albert W. Chow, MD · Answer

Improvement is always a goal and realistic , but not elimination.  We have treated patients with a combined subcision and nanofat grafts with sometimes remarkable improvement.

Hooman Khorasani, MD · Answer

Acne scars can be very distressing and effect how we feel in the presence of others.  I understand your frustration and would recommend that you look into either laser (such as Deep Fx/Active Fx) since non-laser treatment (needle subcision) and Fraxel did not work.   The downtime form the Deep/Active Fx can be several weeks so it is a commitment with great results.  Another less invasion option is Microneedling with or without PRP or Belalfill injectable filler to each spot (this can be time consuming).   In addition, the most important thing to reduce scarring is prevention of further acne with a good skin care regimen.  I would recommend you see a Board Certified Dermatologist or Plastic Surgeon in the area.

Brian S. Biesman, MD · Answer

Thank you for your question.  I am sorry to hear that you have struggled with your acne scarring.  I do understand that you have undergone subcision treatment in the past but there is a great degree of variability in the way this procedure is performed.  I do feel that aggressive subcision is a good option for you.  As you suggest, you may also benefit from injectable fillers.  It does appear that we should be able to improve the appearance of your scarring.

Philip Solomon, MD, FRCS · Answer

Combined therapy with subcision, laser, microneedling, and filler would provide best results.

Michele Zormeier, MD · Answer

Thank you for your question. 
Multi modality treatment may be your best option. Microneedling is a good choice but may require 3-4 treatments. Usually microneedling is done with platelet Rich plasma. Deep FX laser resurfacing will also do a nice job of softening your acne scarring, but again, may require a few treatments. Cool Touch laser treatments also stimulate collagen production to improve acne scarring but multiple treatments are needed. 
Bellafill contains PMMA microspheres which provide a scaffold that supports your own natural collagen production as it develops over time.  Bellafill replaces lost volume in the skin below the acne scar, and is best used for distensible, rolling acne scars. More than one treatment may be needed, but results are excellent and long lasting. It is a great choice for acne scarring on the cheeks. 
Please consult a local board certified facial plastic surgeon for more information and a comprehensive consultation

Yael Halaas, MD · Answer

For complex scarring such as yours, a combination of treatments is typically necessary. A series of RF microneedling treatments, complemented with dermal fillers, can improve the overall texture of the skin. Radiofrequency microneedling can help reduce inflammation with active acne, as well. Injectables will help smooth out the deep forehead lines and other depressions. Chemical peels may be another option, but it depends on your skin type. You should consult with an experienced facial plastic surgeon or dermatologist to design an appropriate treatment plan.

Renita (Lourdhurajan) Rajan, MD, DNB · Answer

Hi,More than fillers in that area, you might benefit better with Botox there,as there are imprint lines, which will do very well with neurotoxin, give it a few rounds though, for better results. Fractional CO2 laser can be used along with BOTOX treatments - I use this combination quite often on the forehead, where deep and thorough subcision is often not possible. Good luck!

Samuel Goos, MD · Answer

Acne scars are always a challenge.  In your case, appears that the movement of your forehead with horizontal lines exaggerate the appearance of the scars.  I would recommend Botox to quiet the forehead to help with horizontal lines.  Combination treatments with long term use of topical retinoids, possible micro needling and series of non ablative fractional laser treatments may help over time.

Acne scar treatment - subcision with filler? (photos)

Answers (14)

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