Would my scar be considered a boxcar atrophic scar? If so, what treatment would you recommend? (photos)

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

Subcision, which is a relatively inexpensive procedure that I have personally been performing since 1995, has a proven track record for elevating and smoothing all kinds of indented scars from all causes, including acne, chickenpox, post-surgical, or trauma. The border of the scar, at least from the photo, appears to more of a rolling scar type. Since all the work of subcision is done below the scar (no cutting, stitches or wounding of the surface), it can be used safely in all skin types. It takes only a few minutes to perform in experienced hands, and there is typically little to no significant downtime. In the days before the pandemic, when people worked in offices, my patients would often come during a lunch break and then return immediately to work. You would be wise to consult with an experienced, board certified cosmetic dermatologist experienced in subcision. Be very cautious when, as you no doubt will be, you are offered this or that expensive, supposedly "next big thing" fraxel laser or RF treatment, as these are far more backed by social influencer marketing hype rather than any hard science. Hope this helps and best of luck.

In my opinion, you have a broad-based atrophic box car. Subcision with PRP should lift the scar. Suction in the post op period is suggested. A second session may be needed. Fractionated laser may be added if needed. Find a scar expert.
Jeff Rapaport MD FAAD
Realself Hall of Fame