Deep brown/dark acne scar on forehead - how can I reduce the size and color? (photos)

Question

Hi, I had an acne and it turned into a deep brown/dark scar. It’s been on my forehead last 3+ months and barely reduced in size or colour. I am medium brown skin. I have done carbon laser peel (no improvement) and microneedling (skin became bit smooth but pigments are dark on the spot)

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 been 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 laser 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

Nelson Lee Novick, MD · Answer

Postinflammatory hyperpigmentation (PIH) can be especially problematic and persistent in skin of color. I have had success in fading these combining in-office manual Dermastamp microneedling accompanied by the topical application of prescription-strength bleaching medications and supplemented by the at-home daily use of prescription bleaching creams. The use of particularly light and energy-based procedures, such as lasers, runs the additional risk, especially in skin of color, for deepening of the pigmentation. So, you were fortunate that this did happen. Make sure to consult an experienced board certified certified cosmetic dermatologist and be very cautious going forward when offered, relatively expensive light and energy-based treatments. Hope this helps and best of luck.

Reuel Aspacio, MD, FAAD - Account Suspended · Answer

Hello, thank you for your questions and photographs. By the photos provided it appears to be post inflammatory hyperpigmentation caused by the acne you have described. Whenever severe inflammation occurs on the skin, such as with acne, there is a potential to cause discoloration. Often times the discoloration can improve on its own. However, if you would like to consider treatment options that can potentially improve the discoloration more quickly, I suggest you speak with a board-certified dermatologist in your area. They should be able to assess your concerns, confirm diagnosis, and provide you with the appropriate treatment options. Hope this helps and take care!

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