Infini vs subcision for pitted scars? (Photo)

You appear to have grade 4 scars with some deep, widened, pitted, and saucer shaped. The first thing I tell my patients is that results of multiple treatments for these scars will not produce normal smooth skin. Improvement will occur with excision, fillers, TCA cross, subcision and infini. I would consult with experts in your area to determine what the best treatment plan is.

So technically grade 3 scars are noticeable at conversational distances but ARE flattened by manual stretching vs grade 4 scars which are noticeable at conversational distance but ARE NOT flattened by manual stretching.  Based on your pictures, these scars appear tethered and not distensible so I would still place them in the grade 4 category.  I agree as well with the treatment plan presented by my colleagues.  Best of luck

This type of scarrign needs surgical excision and then microneedling RF and fillers/subcision to improve it long term.  It will be a number of treatments to get improvement.  Best, Dr. Emer.

In my opinion, when looking at your photos, you have a multitude of different acne scar types.. Treatment of pitted scars depends upon the depth of the scar and the width of the scar. Narrow, deep scars respond best to TCA cross. However, you have saucer shape and tethered scars that would benefit from subcision, Infini, PRP and fractionated lasers. We perform these in one session. I would also recommend pretreatment of your face with bleaching creams prior to any procedures. Expect to do multiple sessions.

OK, I will with respects, disagree on the objective measurement of scarring. Using the objective Goodman Baron Scale, you still have Grade 4 scars, visible from at least 3-4 meters or more. This grading is only for insurance and objective scientific purposes, the B and A with a series of sessions will give you a true reflection. I agree with Dr Rapaport regarding the plan, this should be executed by a  Board Certified Dermatologist. Prof. C L Goh is one of the best in Asia, and he is in Singapore. Go to the NSC or see him privately. Your job is a hard one, if you were in Australia, this would take me 18 months to complete to get to a grade 2-3. The truth with no BS. Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  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.

 

As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations.

 

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. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.