Which procedure would be best for treating my atrophic acne scars? (photo)

Question

I have had 2 subcision treatments done. one with the injection of fillers and another one botox was injected and my doctor recommended me to get 2 more subcision treatments done with fillers but its getting really expensive and I'm worried that it wont work because i saw no difference after 2 treatments. So i was wondering if i should try a different approach like lasers, dermabrasion.. etc.

Raffy Karamanoukian, MD, FACS · Answer

Our office has many different treatments for scars depending on the depth of atrophy or hypertrophy. Scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic scars and indented  scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve  the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional lasers such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture.  Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your scarring.
 
Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Jeff Rapaport, MD · Answer

Treating superficial pitting of the skin typically involves a combination of TCA (Trichloroacetic Acid) cross and fractionated CO2 laser therapy.

1. **TCA Cross:** TCA Cross involves applying high-concentration TCA directly onto the pitted areas of the skin. This causes controlled chemical injury, leading to collagen stimulation and eventual improvement in the appearance of the scars. It's particularly effective for treating ice pick scars and pits.

2. **Fractionated CO2 Laser:** Fractionated CO2 laser therapy works by delivering thousands of tiny, evenly spaced laser beams to the skin. This creates microscopic injuries, stimulating collagen production and promoting skin resurfacing. Fractionated CO2 lasers are effective for improving overall skin texture and reducing the depth of  the scars.

Multiple sessions may be required.  Find a scar expert.

Jeff Rapaport MD FAAD 
Realself Hall of Fame 
Castle Connolly Top Doctor

Which procedure would be best for treating my atrophic acne scars? (photo)

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