Would i benefit from laser or microneedling now? I've tried TCA Cross & subcision with not much improvement?

Given your history and concerns, considering laser treatments or microneedling could be beneficial. Both options have their own advantages and considerations.

Laser treatments, such as fractional CO2 or erbium lasers, can effectively target scar tissue, stimulate collagen production, and improve skin texture. They can be especially effective for resurfacing and tightening the skin, which can help with the appearance of scars. However, it's important to consult with a skilled and experienced provider to ensure the treatment is tailored to your specific scar type and skin condition.

RF microneedling, can also stimulate collagen production and help improve the appearance of scars. RF microneedling combines the benefits of traditional microneedling with the added advantage of radiofrequency heat energy, which can enhance collagen remodeling and skin tightening.

When choosing between laser treatment and microneedling, it's important to consider factors such as the type of scars you have, your skin type, downtime, recovery, and any pre-existing conditions. Each treatment has its own set of pros and cons, and the best choice for you will depend on your individual needs and goals.

Since you've tried TCA Cross and subcision with limited improvement, and you've been using tretinoin for several years, discussing your concerns and experiences with a qualified skincare professional is crucial. They can evaluate your skin's response to previous treatments, assess your current scar condition, and recommend the most suitable treatment plan for you.

Fractional CO2 laser is an excellent tool for skin rejuvenation in our center in Santa Monica. We use the fractional multi-depth ablative approach to help resurface the skin, recontour acne scars, improve incisional plastic surgery scars, and reduce surface irregularities from skin tone to dark pigmentation. Our approach utilizes a multi-depth approach that targets melanocytes in the epidermis and collagen fibroblasts in the dermis. This approach can be combined with a TCA Peel in a process known as a sapphire peel. Fractional laser is excellent for acne scars and contour scars in the skin. Patients are advised to undergo skin protocols with Melarase creams before and after treatment to help reduce pigmentation. Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. After the laser, we expect redness for a few weeks as the skin improves. PRP and Hydrafacial enzyme facials can further improve skin quality after fractional co2.

Best,
Dr. Karamanoukian
Realself100 Surgeon

For unique cases where a variety of modalities could be used to treat the condition, I would suggest an in-person or virtual consultation to develop a custom and effective treatment plan. It is difficult to precisely define the best option without collecting the same information. I suggest reaching out to an expert for a consultation with surgical and non-surgical methods to get a comprehensive option. Best, Dr. Emer.