More Subcision? Or microneedling/TCA cross? (Photo)

Question

After two Subcision treatments for acne scars (no fillers either time) I've not seen the results I hoped for. Unsure whether I should go again, or if another method of treatment would be ideal for my scars. At this point I'm really only interested in Subcision, TCA cross, microneedling, and filler injected directly into/under the scar by someone with experience using filler in this way.

Raffy Karamanoukian, MD, FACS · Answer

Our treatments use combination therapy to improve the epidermis and dermis for most deep scars. The options available for acne scars depend on the character of your scars, in terms of topography and contour. We see atrophic and hypertrophic acne scars, as well as scars that have hypo and hyperpigmentation. We begin each scar evaluation with an assessment of scar quality and subtype. Our main concern is rebuilding collagen and that is why we use a HIDEF protocol that includes combination therapy. Morpheus 8, scar subcision, fibrous release, fractional laser, CO2 laser, Thulium laser, PDL Vbeam laser, and fractional resurfacing can be used in addition to TCA Cross and chemical peels to further improve skin. Patients should start Melarase AM and Melarase PM for active hyperpigmentation. Always begin with a consultation to decide whether early subcision should be started.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Best, 
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I have been performing subcisions, (with filler or without, as needed) for acne scars (as well as for other indented scars) since 1995. They are best reserved for treating more broad based scars, such as boxcar and rolling scars. (TCA CROSS, which I have been performing for over two decades, is best for ice pick scars and dilated pores and microneedling best for improving superficial, surface texture and color irregularities, rather than as a primary scar treatment).  Your doctor should have told you that a 60%-80% overall improvement in "mature" (i.e. over three month old scars) can generally be expected and that this improvement may take anywhere from two to six treatment sessions per scar  (on average three to four treatments per site) in order to achieve this. So, being disappointed after simply two sessions is more the norm than the exception and that your current concern likely stems more from not having been given realistic expectations than from a failure of treatment at this point. You would be wise to make certain that you are consulting with an experienced, board certified cosmetic dermatologist acne scar treatment specialist. So hang in there, and best of luck.

Mats Hagstrom, MD (license on probation) · Answer

Treatment of acne scars is inherently difficult. None of the treatment options you have listed have good track records for the treatment of permanent acne scarring.
Selective, direct excision is the best method, but I can understand why patients may be reluctant to choose that option.
Keep your expectations on the low side for any of the above stated treatment choices
Best,
Mats Hagstrom, MD

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