Best treatment for my acne scars? (Photo)

"​Acne scars need a combination approach for long-term improvement. Everyone has a unique pattern of acne scarring, and most people have various types of scars, so we create a tailored treatment plan for each patient. We often use:
- Injectable fillers like Bellafill and Sculptra (with or without subcision) for atrophic, indented scars.
- Subcision for depressed, tethered scars.
- Vascular lasers like Yellow laser, Aerolase, excel V, BBL, or IPL for redness or thick acne scars.
- Lasers such as Fraxel, Erbium, CO2, Halo or fractional radiofrequency (Venus Viva, Skinfinity, Morpheus, PiXel8, Fractora, Intensif microneedling RF) for textural issues and superficial scarring.
- TCA CROSS and punch excision for deep ice pick scars and narrow box car scars.

All lasers are combined with microneedling/PRP to improve the results and accelerate your healing time. Keep in mind that a personalized combination treatment by an expert physician will give you the improvement you're looking for. I recommend getting a formal evaluation with an experienced cosmetic dermatologist and acne scarring expert. Best, Dr. Emer. ​"

Scars can be temporary or permanent and there are many aspects of scars that can be improved. During your consultation, we look to determine the textural changes, hypopigmentation, hyperpigmentation, scar color, scar contour depth, scar atrophy, inflammation, and scar thickness. Once complete, a HIDEF protocol is established that includes pigmentation protocols to either lighten or darken scar tone, retexturization of scars, inflammatory mediators, lasers, and contour correction. All of these require time and multi-plane correction.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello SF. You are a good candidate for TCA cross, not subcision. The challenge with subcision is that it works better with wider, deeper scars. You have very superficial scars, pinpoint or ice pick. For these, TCA cross is a great option.

Two other points. First, if you did not have bleeding during your fractional resurfacing procedures, then you did not get a deep enough procedure to have the intended effect. So many practices are concerned more about how much downtime the patient has than in delivering great results. So a recovery from a deep fractional resurfacing procedure should be 7 days or so, and you would look bloody int eh treatment areas after the procedure (because it needs to be deep enough to get into the dermis. Second point, is that it's not the brand of laser so much as it is how the procedure is performed.

I'm sorry for the lack of success with the the "bells and whistles" fraxel lasers. I have been cautioning readers for years that the hard science to back up the use of thse supposedly "next big thing" energy-based devices lags well behind the heavy marketing to promote them. Sorry. Tried and true and relatively inexpensive treatments that each have a more than two decades of track records for efficacy and safety include subcision for elevating and smoothing boxcar and rolling scars and TCA CROSS for ice pick scars and dilated pores. Once the aforementioned are performed, then professionally performed microneedling may be considered to help better blend the treated areas with the surrounding normal skin. I am no fan of the use of permanent fillers, since permanent fillers can translate into permanent complications, such as disfiguring lumps and bumps, that may not only appear soon after treatment, but can first appear five, ten or even twenty+ years later. Make sure to consult with a board certified cosmetic dermatologist with experience and expertise in treating acne scars. Best of luck.

Acne scars usually require a combination of treatments. TCA CROSS is beneficial for deep or ice-pick scars, adding subcision can help. Ablative and non-ablative resurfacing lasers, as well as RF microneedling can also help and several treatments are necessary. There is some hyperpigmentation so sun avoidance and fading products including retinols would help. The white scars may not repigment.
Seek treatment with a cosmetic dermatologist who offers these treatments and can address these concerns.

Subcision with fat grafting that includes use of both microfat for depressed scar and nanofat to improve texture and pigmentation.