Subcision and Fraxel for Boxcar Scars? (photo)

Question

I plan on receiving Fraxel but was interested in receiving subcision before hand in hopes that both combined would give a better result. Would subcision be recommended for my scars. I feel that it would definitely help on my right cheek especially towards the middle and outer side. On my left side would it help the boxcar scar on the outside or the line on the inside at all? I understand that there is no such thing as 100% improvement but would it be possible to look like the third picture?

Raffy Karamanoukian, MD, FACS · Answer

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

Lawrence Kass, MD · Answer

I agree with you! If you only proceed with the Fraxel, I think you will be disappointed. You need to find a physician who will work with you, employing different modalities to achieve optimal results. you do not want to proceed with a doctor who offers you Fraxel alone.

Cheryl M. Burgess, MD, FAAD · Answer

Fractionated erbium or carbon dioxde laser treatments are used commonly for acne scars such as boxcar, rolling hills and ice pick scars. Subcision is more helpful for rolling hill type or depressed acne scars and needle stippling is helpful for icepick scars. I don't guarantee that your acne scars will improve to the third photograph; however, you will see improvement.

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