Is subcision with silicone injected into acne scarring safe? See pictures of current scarring on my olive skin tone (Photo)

Question

I have done 8 RF microneedling sessions over 2 years with not much improvement on my acne scars. I don't break out as much now so I am looking for the best treatment for my scars. A surgeon recommended I get subcision with little silicone injected into my acne scars. He said silicone is better than filler for scars since it's permanent. He said my scarring isn't very deep& I should see improvement. Is silicone safe to inject in the face for scarring? Are there any long term side effects?

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

Jeffrey H. Spiegel, MD · Answer

Acne scaring can be treated in many ways.  Silicone injection would not be, in my opinion, a contemporary approach. There are many other far better ways to address acnes scars which will not have the long lasting (permanent) potential complications of silicone.  Watch our videos to learn more.

Nelson Lee Novick, MD · Answer

I am not surprised that the RF microneedling was not successful. I have been cautioning my regular followers for years that the use of the relatively expensive, "bells and whistles" fraxel lasers and RF gizmos are backed far more by social media hype buzz and marketing hype than hard science. Sorry for the wasted time and money. Secondly, manual microneedling (no need for the added expense or risks of RF microneedling), which I have been performing for almost a quarter of a century is not a particularly good primary treatment for acne scars. It is far better as a final "polishing" step--for blending the  surface of the scars better with the surrounding normal skin--after more effective treatments have been  performed. Subcision, which I have been performing since 1995, is an excellent technique for elevating and smoothing indented boxcar and rolling scars. The added use of a permanent filler, such as silicone, runs the risk for the subsequent development--which can be anywhere from immediately following treatment to 20+ years later--of disfiguring adverse reactions that can be very difficult to treat. So, I would suggest "buyer beware" when considering this. You would be wise to consult with a board certified cosmetic dermatologist scar specialist. Hope this helps and best of luck.

Is subcision with silicone injected into acne scarring safe? See pictures of current scarring on my olive skin tone (Photo)

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Is subcision with silicone injected into acne scarring safe? See pictures of current scarring on my olive skin tone (Photo)

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