What treatments are right for deep acne scars on my nose? CO2 laser resurfacing or steroid injection? (Photo)

A combination of Bellafill, a long lasting filler, CO2 laser therapy are all great therapies that can be used separately or in combination to improve skin texture when it comes to acne scars. In addition to treating skin texture, acne scars can also have a component of hyperpigmentation that can also be treated with Intense Pulse Light or chemical peels. Approximately 3-5 sessions, typically spaced one month apart with diligent sunscreen use will be sufficient in obtaining significant improvement in both texture and color of the skin. 
Thanks!

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne 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 acne 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 acne scars and indented acne 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 acne 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

A combination approach will give the most improvement. These types of scars need a combination of lasers, microneedling/prp, Cosmelan, subcision and fillers. Co2 is the best laser for scars, but Erbium is a great alternative. It will take a series of treatments and will need some treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

I always advise patients to have steroid injections as a last resort. CO2 laser will not lift the deep art of the scar, but can be used to soften the edges or shoulders of the scar. It helps, but is not perfect. The purpose of microneedling is to try to release the scar tissue beneath the indentation which is pulling it downward. I would advise you to wait quite a few months (ideally a year) following the microneedling before deciding it didn't work.

Impossible to commit based upon the photo, I would have a best guess that TCA CROSS - 3 sessions followed by one session of erbium fully ablative should improve things by 80%Acne scar revision is a sub-specialised field. For the best results, one should target the acne scar type with ideal treatments and not just one device. The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help.
For example deep ice pick scars, and narrow box car scars can be treated with TCA CROSS peels, mixed scars, rolling, and atrophic scars treated with fractional devices such as Fraxel, fractional lasers, PRP and INFINI radiofrequency. Atrophic scars (depressions) can be treated with either fat grafts, or with HA dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that we use include punch elevation, surgical elevation, punch excision and traditional excision of focal scars.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. In the majority of patients its finding the correct combination that give you best results, and everyone is unique! All the best,
Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.