Which procedure would best address scarring from cystic acne?

Question

After dealing with cystic acne my skin is almost clear, but I have some minor scaring I would like to address. What procedure would be best for my type of scarring?

Nick Slenkovich, MD · Answer

Hello, my name is Lauren, and I’m the aesthetics injector at Colorado Plastic Surgery Center. CO2 laser treatments and microneedling are both effective options for improving the appearance of acne scars. I recommend scheduling a consultation with your provider for a comprehensive skin and facial assessment to determine the most appropriate treatment plan for your needs.

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
Realself100 Surgeon

Barbara Padilla, MD · Answer

Thank you for your question! At our practice we recommend microneedling or laser resurfacing in regard to acne scaring. Microneedling creates micro controlled wounds on the area of concern which stimulates the body's natural healing process. During this healing process, collagen and elastin are increased which helps with scaring, fine lines, wrinkles, and skin texture. Juliet laser resurfacing works by delivering 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 3-4 days after the procedure, revealing renewed, restored skin.

Falguni Patel, MD, FACOG · Answer

Microneedling would be a great treatment for you to help with acne scars and texture of the skin. If your still dealing with active acne you can look into VI Peels which is a medium depth chemical peel to help treat the cystic acne as well as the scars.

Nelson Lee Novick, MD · Answer

Unfortunately, the resolution from the photos provided makes it very difficult to determine the kinds of acne scarring present. 
However, there are some simple rules to follow: For treating acne scars, keep the treatments simple, relatively inexpensive, and look for those that have proven their value in decades of real-world use for both safety and efficacy. The following treatments meet those criteria.
For treating ice pick scars, consider TCA CROSS, a technique that I have been using for nearly a quarter of a century, with a proven track record for safety and efficacy in all skin types.
For Indented scars, such as rolling scars and boxcar scars, consider subcision, which I have been using for coming up on thirty years, for elevating and smoothing them. It, too, has a proven record for safety and efficacy in all skin types.
And for superficial, surface, texture and/or pigmentary irregularities, consider professionally performed, manual microneedling (no need for the added expense and risks of RF micro needling) accompanied by the application of the appropriate Rx topicals. I personally have nearly 25 years of gratifying experience using this approach for these kinds of issues in all skin types. 
Finally, I would suggest execising a great deal of "buyer beware" caution when considering the use of so many of the expensive, so-called, "next big thing," often here-today-gone-tomorrow, light and energy-based devices being advertised out there, as the hard science to back of their use lags well behind the heavy marketing hype and social media buzz that promotes them. 
You would be wise to consult with an experienced, board certified certified cosmetic dermatologist acne scar treatment specialist. Hope this helps and best of luck.

Anna Chacon, MD, FAAD · Answer

When it comes to addressing scarring from cystic acne, the best procedure can vary depending on the type and severity of the scarring, as well as your skin type and individual preferences. Here are some commonly recommended procedures for treating acne scars:

Laser Resurfacing: This procedure uses laser technology to remove the damaged outer layers of skin and stimulate collagen production, helping to improve the texture and appearance of scars. Fractional laser treatments, such as Fraxel, are popular for treating acne scars with minimal downtime.

Microneedling: This involves using a device with fine needles to create controlled micro-injuries in the skin, which stimulates collagen production and can improve the appearance of scars over time. It is often combined with radiofrequency for enhanced results.

Chemical Peels: Medium to deep chemical peels can help reduce the appearance of acne scars by exfoliating the top layer of skin and promoting new skin growth. The depth of the peel will be chosen based on the severity of the scars.

Dermal Fillers: For certain types of acne scars, particularly those that are depressed or pitted, dermal fillers can be used to temporarily lift the skin and create a smoother surface.

Subcision: This is a minor surgical procedure where a needle is inserted under the skin to break up fibrous bands causing the scars, allowing the skin to lift and appear smoother.

Punch Techniques: For deeper scars, punch excision or punch elevation techniques can be used to remove or raise scar tissue, which is then repaired with sutures or a skin graft.

It's important to consult with a dermatologist or a skincare specialist who can evaluate your specific type of scarring and recommend the most appropriate treatment plan. They will consider factors such as your skin type, the extent of scarring, and your personal goals to determine the best approach for you.

Camille Cash, MD · Answer

SkinPen microneedling is a great way to improve the appearance of acne scars.  The treatment is done in the office with no downtime.  Typically several treatment sessions are needed for optimal results.  We also recommend using medical grade skin care products like Transform MD and wearing sunscreen every day.  You can learn more about SkinPen by visiting my website.

Daniel P. Markmann, MD · Answer

Thank you for the question and including pictures.   There are 2 types of acne scars, Pits aka Ice pick scars and craters.   For the ice pick scars, the best treatment is micro excisions.  This is where the hole is cut out using a micro scalpel and closed with one stitch.   The Crater scars can be treated with CO2 laser resurfacing, Radiofrequency Microneedling.  The CO2 treatment is more aggressive with longer healing time.  Another advantage of Radiofrequency microneedling is that it actually helps treat cystic acne.   The most important treatment of acne scars is to prevent them by getting your cystic acne under control.  Accutane is a great treatment to get rid of your cystic acne.  But if you do that, then I wouldn't recommend CO2 laser until a couple of years after you stop the accutane.

Which procedure would best address scarring from cystic acne?

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