Which would be better for my skin texture/scarring: RF microneedling, full ablative erbium, or a deep peel?

Question

One this to note is I tend to get an impaired skin barrier and have mild rosacea

Nelson Lee Novick, MD · Answer

Ablative lasers and deep peels, much like dermabrasion are aggressive procedures that carry a real  risk of scarring and dyspigmentation problems. TCA CROSS, on the other hand, which uses a very potent acid placed deeply within an ice pick scar or dilated pore can work well for narrowing these defects without broadly affecting the surface of the skin. As a finishing step, conventional microneedling (no need for the additional "bells and whistles" radiofrequency) may be used to better blend any residual superficial skin color or textural irregularities with the surrounding normal skin. Make sure to consult with a board certified cosmetic dermatologist, and exercise a healthy dose of "buyer beware" when evaluating claims for this or that latest fad, relatively expensive laser or RF device to come on the scene. It is worth remembering that in their rush to capitalize on the latest "next big thing" treatment, device manufacturers often let the hard science to support its use lag behind. Best of luck

Jason Emer, MD · Answer

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars. 
- Subcision for depressed, tethered scars. 
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars. 
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring. 
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Robert T. Buchanan, MD (retired) · Answer

I would not recommend any of the 3 modalities you mention. The Erbium laser is an outdated option. It should only be used with another laser. The Erbium laser only ablates without stimulating collagen and the results are very inferior to a CO2 laser or when the erbium is combined with another one to stimulate collagen production. Besides it is overkill, like the deep peel, for what you have. Microneedling (without the RF, which adds nothing) is reasonable, but you first need to be on tretinoin (Retin-A) daily to stimulate collagen production. I would see someone else who does not have a lot of expensive equipment they need to use to recoup their investment.

Which would be better for my skin texture/scarring: RF microneedling, full ablative erbium, or a deep peel?

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Which would be better for my skin texture/scarring: RF microneedling, full ablative erbium, or a deep peel?

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Everything you need to know about Skin Rejuvenation

Our mission is to create a world where every investment in modern beauty is Worth It.