Acne scar removal - what is the best treatment? (Photo)

Question

Helw respected Dr I have taken 3 session of subcision and 9 session of vivace kindly suggest me best treatment for these scars removal

Nelson Lee Novick, MD · Answer

I'm sorry that you have been so disappointed with your treatments to date. I am not surprised, however, that you have not had satisfaction with your prior treatments. For one thing, miicroneedling treatments are best reserved for a final "polishing step" once other more appropriate treatments have been done. It is not particularly effective as a first-line treatment. Besides, I have cautioning my regular followers for years to exercise a great deal of "buyer beware" caution when being hawked RF microneedling treatments even for the polishing step because RF simply adds to the expense and to the risks. Sorry.
Regarding subcision, at least from the photos provided, there appear to be a significant number of ice pick scars for which TCA CROSS, not subcision, would be the treatment of choice. A Field Subcision, on the other hand, of the cheeks might have been a far more successful initial approach.
You would be wise going forward to consult with a board certified cosmetic dermatologist acne scar specialist and best of luck.

Anna Chacon, MD, FAAD · Answer

Hello, and thank you for your question and photo.

You've already undergone several sessions of subcision and microneedling (Vivace), which are excellent treatments for atrophic acne scars. Based on the residual scarring seen in the photo, here are some next-step options that may further improve your results:

Fractional CO2 or Er:YAG laser resurfacing: These are among the most effective treatments for deep acne scars. They work by removing layers of damaged skin and stimulating new collagen formation.

TCA CROSS (Trichloroacetic Acid Chemical Reconstruction of Skin Scars): Ideal for ice pick or very deep scars. This technique uses high-strength TCA applied directly into the scar to promote collagen remodeling.

PRP (Platelet-Rich Plasma) with microneedling or laser: PRP can accelerate healing and improve outcomes when combined with other modalities.

Dermal fillers: Temporary fillers like hyaluronic acid or longer-lasting ones like Bellafill can help elevate deeper, tethered scars for a smoother surface.

Radiofrequency microneedling with deeper needle depth: If not already used, more aggressive settings or devices like Morpheus8 may offer additional improvement.

Each approach can be tailored based on scar type, skin tone, and healing capacity. A combination of these treatments over time typically yields the best results.

Hope this helps clarify your options!

Raffy Karamanoukian, MD, FACS · Answer

Acne scar treatments require precision and attention to detail. There are several types of acne scars, including atrophic, hypertrophic, PIH hyperpigmented, and hypopigmented scars. Depending on the types of scars you have, our office can recommend a Hidef treatment protocol that can recontour existing scars and reduce complexion irregularities. The results are simply life-changing.
 
As a general rule, we recommend fillers, subcision, acne surgery, RF ablation, and laser ablation to help with atrophic scars. Hypertrophic and keloid acne scars require pulsed dye laser and IIT SC. PIH scars require chemical peels, Melarase creams (AM and PM) and laser.
If you have ice-pick scars, we recommend RF ablation and TCA Cross.
Best,
Dr. Karamanoukian
Realself100 Surgeon

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