What can I do to improve the acne scars on my face? (Photos)

Question

I’ve been getting an herbal peel to improve my skins texture and scarring but I feel like it’s not helping as much. My Aesthetician told me that I must do 6 treatments to see results (currently have done 4), and that later she will do IPL to reduce scarring, but after reading reviews on IPL I’ve heard that it doesn’t help with indented scars. What should I do?

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

Anil R. Shah, MD · Answer

Acne scarring is one of the most difficult conditions to treat.  Thankfully, there have been some major advancements over the last several years.  I believe combination therapy offers patients the most benefit.  Here are some modalities that are effective:
 RF needling- Needles combined with Radio Frequency create microchannels in the skin, creating collagen. There are many great systems available, but seek on that is safe for all skin types. I like Fractora.
 Pinpoint irradiation- Specialized technique I use where strong beam profile of a Co2 laser is directed to each individual scar.  Think of it as painting each scar with laser to get the maximum benefit.
 Erbium- An ablative laser to improve skin texture and improve collagen production.
 Microneedling- Microneedling used alone is  good, but it is especially effective as an add-on to the above treatments. Combining different modalities increases efficacy.  
 Cross-TCA- 100% acid directed at the scar will build collagen.
IPL- We have the most powerful IPL  to help treat pigmented and vascular lesions. With acne, patients are left with inflammation under the skin and hyperpigmentation. This treatment helps improve the complexion and clarity of the skin and it is only recommended for patients with a fitzpatrick scale of 1-4.
 Subcision- Cutting the scar free from the tissue and filling in depressions with either a High G prime filler or Bellafil. This requires a skilled and experienced physician to perform. 
Best,Anil Shah

Jeff Angobaldo, MD · Answer

Thank you for your question.  IPL treatment treats red vessels, hyperpigmentation and it improves the texture of your skin by producing collagen and elastin.  Laser hair removal is best performed with a diode, yag, and alexandrite laser.  Always consult with a physician to make sure you are a good candidate.

Jason Emer, MD · Answer

Acne scars need a combination approach for improvement.  For the best results, one should target the acne scar type.  As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  Typically you need fillers like bellafill and sculptra for atrophic indented type scars with or without subcision.  Subcision for depressed tethered scars.  Vascular lasers like yellow laser, aerolase, excel V or IPL for redness or thick scars. And lasers such as fraxel, erbium, co2 or fractional radiofrequency like venus viva, skinfinity, intensif microneedling RF for textural issues and superficial scarring.  Deep ice pick scars and narrow box car scars are best treated with TCA CROSS and punch excision.  All lasers are combined with microneedling and PRP to get even better results and improve healing times.   The majority of patients will have a collection of different scar types, and hence a tailored treatment plan is needed by an expert physician.  It is never about the laser or product that gives the results, its about the expert behind the equipment that gets you the outcome.  Scars cannot be cured and will need life-long treatments to maintain and build on the results.  Best, Dr. Emer.

Michele S. Green, MD · Answer

Thank you for posting your photos since it is clear from them that you need something stronger like the eMatrix laser.  You have many indentations and the texture needs to be treated.  The eMatrix through radiofrequency will produce new collagen and heal up your acne scars.  It may take between 3 and 5 treatments to correct your scars. Please consult an expert in acne scars for the best cosmetic results. Best, Dr. Green

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