6 months post Accutane, what acne scar treatment would be best option for my dented scars? (photos)

Question

I have finished taking Accutane about 5-6 months ago. Now, I have been applying Stieva-A (same as Retin-A) 0.025% for 2.5 months (still breaking out though). I decided it would be better to stop applying Stieva-A and plan on getting actual acne scar treatments. What treatments would be the best option for my scars? I have been suffering from acne and scars for almost entire my life... I am extremely stressed. Please advise me.. Thank you very much.

Raffy Karamanoukian, MD, FACS · Answer

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

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. ​"

Luis A. Cenedese, MD, FACS · Answer

Loss of dermal volume is best replaced with subcision and fat or Sculptra injections.  Bellafill and hyalurinoic acid fillers are less permanent solutions.  Resurfacing with Dermabrasion or CO2 lasers or collagen stimulation with PRP injections or RF treatments are additional options.  Typically two two three treatment modalities are required to obtain optimal results.
Ice pic marks and small craters will benefit from TCA or Phenol local treatments.
Please consult in person with an experienced Board Certified Specialist prior to making treatment decisions.
We will be happy to email you our acne treatment regimen.

Richard Ort, MD · Answer

it looks like you have primarily ice pick scars and some narrow boxcar scars.  I would recommend starting with TCA CROSS treatments.  Find an acne scar expert.Regards,Dr. Ort

Davin Lim, MBBS, FACD - Account Suspended · Answer

Agree, TCA CROSS in combination with RF or low density CO2 lasers - you will also require subcision and HA filler. For this type of patterning, I prefer blunt canular subcision over NOKOR, at least for the first few sessions. Prof CL Goh, leading scars expert in SG .
Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help. 
  
 
  
As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations. 
  
 
  
The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

6 months post Accutane, what acne scar treatment would be best option for my dented scars? (photos)

Answers (5)

Answer: Ice pick scars

Answer: Ice pick scars

Answer: TCA CROSS, cannular subcsion, RF microneedling.

Answer: TCA CROSS, cannular subcsion, RF microneedling.

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Everything you need to know about Accutane

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6 months post Accutane, what acne scar treatment would be best option for my dented scars? (photos)

Answers (5)

Answer: Ice pick scars

Answer: Ice pick scars

Answer: TCA CROSS, cannular subcsion, RF microneedling.

Answer: TCA CROSS, cannular subcsion, RF microneedling.

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Recommended reading

Everything you need to know about Accutane

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