Best Treatment Options for my Acne Scars? (photo)

I am considering having subcison done for my moderately severe rolling and boxcar scars on both cheeks.I was wondering if my shallower boxcar scars would benefit for this procedure as well. And what the average cost of subcison is for both cheeks? Would I also benefit from any other treatment to improve skin texture and volume with fillers?

Doctor Answers 2

Rolling scars is the most difficult scars to treat but can be done

I can see from your photos the following: various depths of rolling scars with shoulders of different heights, box scars and some ice picks cars. You also have post inflammatory hyperpigmentation.  It seems your scars emanated from deep nodular cystic acne that obviously were not well controlled in the past. Subcision alone has a very high rate of recurrence. In subcision, the scar that has rooted down to the deeper tissue is cut. If the roots are simply cut, they will re-attach, which is the reason for high recurrence. To minimize or prevent this from happening, a buffer such as dermal filler or PRP is usually injected in the area of subcision to prevent the cut scars (the roots) from re-attaching themselves. In the best case scenario, your rolling scars will be subcised. I take a laser to sand down the higher shoulders of your scars so they will be more even with the normal level of the skin. Then I take another laser and drill down thousands of holes into the scars to break the scars apart. How far down? Depends on how thick the scars are. The final step is to fill in the subcised area with either dermal fillers or PRP. I prefer PRP because this is from your own blood. During the healing process, your scars will be replaced by normal skin. Now, I assume that you may be of darker skin type like Asian or Hispanic. All of the above can be done. However, the aggressiveness of treatments need to be toned down to minimize the risk of post inflammatory hyperpigmentation.

Best of luck.

Fresno Physician
5.0 out of 5 stars 1 review

Acne Scar Treatments

The average cost of subcision varies; you should check with your dermatologist for a price quote.  I do find that subcision, while effective for the type of acne scars pictured, works best when combined with another type of acne scar treatment.  Subcision can be most useful when performed prior to laser treatments, such as the Fraxel or Fractional CO2 laser.  Fillers are another way to improve the texture of acne scars - they provide an immediate benefit, but the results are temporary (since they do not stimulate the body's own collagen to fill in acne scars, as lasers do.)  

Eric Schweiger, MD
New York Dermatologic Surgeon
3.8 out of 5 stars 13 reviews

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