Exactly what combination treatments are needed for my acne scars? (Photos)

Question

Have a nice day! I would like to ask you about my acne scars. What treatments would help most effectively? What combination treatment would be good for it? Would Punch Excision be good for the scars on my forehead? Male, 26 years old, 195 cm, 85kg.

Barbara Padilla, MD · Answer

Thank you for your question. We recommend Juliet laser resurfacing in regard to acne scars. The Juliet handpiece delivers energy in a small grid to the treatment area, treating both the top and deeper layers of the skin, while stimulating your body’s natural creation of new collagen. The superficial layer of your skin will slough off in 3 or 4 days after the procedure and continued collagen production will occur. Micro-needling is another effective treatment to diminish acne scars. This procedure creates micro injuries to the skin to stimulate the natural healing process and increase collagen.

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

At least from the photos provided, the forehead appears to have several deeply Indented boxcar-like scars. If this is indeed so, then subcision would can be used to elevate and smooth the scars. Once, elevated, then professionally performed manual Dermastamp microneedling can be performed to help to better blend the surface of the scars, in both texture and color, with the surrounding normal skin.
Punch excision runs the risk for the subsequent development of stretch scars and even stitch tracks, especially when performed in areas subject to muscular tension, such as the forehead. 
And finally, a heavy dose of "buyer beware" should be exercised if being offered fraxel laser and RF treatments, PRP, etc., as the hard science to back up the use of these often expensive gizmos and methods lags well behind the heavy marketing and social media buzz to promote them. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

For addressing acne scars, a combination of treatments is often the most effective approach, as it can target various types of scarring simultaneously. Here are some commonly used combinations:

CROSS Technique, Subcision, and Microneedling: This combination is particularly effective for atrophic scars. The CROSS technique uses chemical peels to stimulate collagen production, subcision releases fibrotic strands beneath the scars, and microneedling further promotes collagen synthesis.

Laser Therapy and Platelet-Rich Plasma (PRP) Injections: Laser treatments can resurface the skin and reduce scar depth, while PRP injections use growth factors to enhance healing and collagen production. This combination is beneficial for improving skin texture and reducing scar visibility.

Topical Retinoic Acid and Glycolic Acid (RAGA): This non-invasive option can improve mild to moderate acne scars and reduce post-inflammatory hyperpigmentation. Retinoic acid promotes cell turnover, while glycolic acid exfoliates the skin.

For scars on the forehead, Punch Excision might be suitable for deep, isolated scars. This technique involves surgically removing the scar tissue and is often followed by other treatments like laser therapy to smooth the skin.

Ultimately, the best treatment plan depends on the specific type and severity of your scars. Consulting with a dermatologist will provide a tailored approach, ensuring the most effective combination of treatments for your skin type and scar characteristics.

Glenn Murray, MBBS · Answer

Hi, 
I recommend an ablative resurfacing laser like C02, Pixel or erbium. Another option may include Morpheus 8 (RF needling) at least 3 treatments, 6 weeks in between.

Exactly what combination treatments are needed for my acne scars? (Photos)

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