Treatment of Severe Acne Scars
I personally believe that the treatment of acne scars should include three basic considerations. (1) Filler or fat to correct dermal and subcutaneous atrophy if present (2) Subcision to release tethered and bound down scars if present (3) Use of an energy based devices to stimulate the formation of new collagen and elastin in the dermis. Clinical judgement should be used to select the proper filler and energy based device (RF or Laser) depending on the patients age, skin type, type of scar and lifestyle. Best of luck.
Acne scars- skin type, scar type, down time...
The bad news? You have extremely difficult to treat acne scars in Ethnic skin type- this makes treatments a little harder but achievable. Good job for taking angled lighting, as most patients take non- shadowed direct light, which does not tell the entire story.
Firstly, you have multiple scar types- rolling, atrophic, tethered, and box car scar. The tethered scars will be your rate limiting factor. You will need subcision. Multiple treatments, followed by non-laser energy devices such as INFINI RF ( In my opinion this out performs fractional CO2, as in your skin type RF INSULATED micro needling will not give you post laser skin darkening or PIH). You will require 3-4 sessions.
Shallow box car scars, ice pick- easy. TCA CROSS.
Some of the atrophic scars will come good with INFINI, but as suggested by Dr Ridenour, you will need filler- fat transfer ( I prefer filler as it is more predicable, and gives the finesse I need).
See the attached 21 min video in the web reference to understand the whole process of scar revision. If you look at my B and As, no two patients are alike, scar revision has to be tailored the patent.
All the best
Dr Davin Lim
Laser and Aesthetic Dermatologist
Acne Scars – Combination of Treatments Needed
The best treatment for acne scars depends upon an
individual’s skin type, age, ethnicity, sun exposure, overall health and most
importantly, the type of acne scars present (ice pick scars, boxcar scars,
rolling scars, hypertrophic scars and variable degrees of hyperpigmentation).
In order to give you an accurate treatment plan, a consultation is required to
properly assess your skin.
An important step for all skin types is sun protection
including the use of daily sunscreen, sun hats and sunglasses, all of which
help prevent aging and sunburns.
When it comes to acne scar treatments, a combination of
treatments are available including cosmeceuticals (medical grade skin care
products specific for acne including ZO® Skin Health or ZO® Medical,
Skinceuticals® or Glo-Minerals®), advanced laser resurfacing procedures (CO2
laser, Er:YAG laser, Fraxel DUAL®, PicoSure® FOCUS Lens Array), chemical peels
(light, medium, deep including the blue peel), dermabrasion,
augmentation/fillers, excision and/or subcision, punch techniques,
microneedling/rolling, injections (corticosteroids, 5-FU), cryosurgery,
electrodesiccation and microdermabrasion.
These are advanced techniques so be sure to get an
experienced dermatologist or plastic surgeon consultation for recommendations
and treatment options.
Severe Acne Scars and Treatment
Your scars are best treated with a combination of fillers to replace the lost volume and lasers. There is no single treatment, particularly with your skin type to treat you in one session. This is a process and cannot be corrected "overnight". Please consult an expert. Best, Dr. Green