What procedures should I consider to minimize the appearance of my rolling scars? (photos)

Question

I’ve gotten done RF microneedling (4), fat grafting, subscion (3), excision, moderate peels, microneedling, injections. So what else can I do to help these rolling scars look less visible? A mini facelift, c02 laser, dermabrasion? I’m tired of hiding my face with my hair . What else can I do?

Nelson Lee Novick, MD · Answer

I'm really sorry that you have already been through the mill (and the expense) of so many different kinds of acne scar treatments. My regular followers would tell you that microneedling is best reserved as a "polishing" step for acne scars (rather than a primary treatment), in order to better blend residual, superficial, surface color and texture irregularities with the surrounding normal skin. It is not a particularly effective primary treatment for deeply indented scars. What's more, adding RF to Microneedling simply adds to the expense of the treatments, as well as to the risks for adverse reactions. So, no surprises at the lack of success there.
Excisions and punch excisions risk the subsequent development of stretch scars and tram track stitch marks.  Fat grafting and fillers alone seldom work. Individual subcisions, properly performed  by an expert can be helpful, but typically on average at least three to four treatment sessions per site are required to ultimately achieve between a 60-80% overall improvement in appearance in the vast majority of instances. 
CO2 laser, much like conventional dermabrasion, is an aggressive, abrasive, procedure that carries significant downtime and again risks of scarring. And a minilift is surgery and thus carries the expense and the risks of downtime and post-surgical complications, 
At least from the photo provided, a Field Subcision, on the other hand, which is intended to help to elevate and smooth an entire field of indented scars in an entire anatomic unit, such as the cheek, temple, and chin areas, when properly performed by an expert, would seem like a very reasonable, minimally invasive, nonsurgical approach. 
You have been through the mill already and going forward it would be wise to consult with a board certified cosmetic dermatologist scar treatment expert and avoid any further venues hawking this or that expensive, unproven light or energy-based "bells and whistles" gizmos. Hope this helps and best of luck.

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

What procedures should I consider to minimize the appearance of my rolling scars? (photos)

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What procedures should I consider to minimize the appearance of my rolling scars? (photos)

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