Ice pick and boxcar scars, redness, and dilated pores. What is the best treatment for me? TCA cross and Infini? (Photos)

Question

I have dilated pores, icepick & boxcar scarring. Finished Accutane 2 mo ago- now looking into scar treatments. What should my plan be? TCA Cross or Infini first? Are my scars deep/narrow enough for TCA? Can I do it w/ a toothpick w/ caution? What %? For RF needling, does it matter whether it's Infini/Intracel? Intracel is by a more experienced Dr. Should I treat full face or only target areas? Can I treat my undereye? Are there better alternatives for my issues? When do I start topical Vit A?

Jeff Rapaport, MD · Answer

In my opinion, it is difficult to precisely view your scars from the photos. It looks like you have ice picks, narrow boxcars, large pores and a saucer shaped scars. My initial treatment would be with TCA cross. It's important because of your skin color to pre-treat with bleaching creams. Depending upon the results of the TCA cross, subcision, PRP, fractionated laser and infini can be performed. Find an find an acne scar expert. Ask to see photos.

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

Jason Emer, MD · Answer

A combination approach will give the most improvement. These types of scars need a combination of lasers, microneedling/prp, Cosmelan, TCA cross, punch excision and fillers. Infini is a popular treatment, but I prefer Intensif because the needles are non-insulated and it gives more robust results. It will take a series of treatments and will need life-long treatments to maintain. I recommend getting a formal evaluation with an acne scarring expert. Best, Dr. Emer

Davin Lim, MBBS, FACD - Account Suspended · Answer

100% agree with Dr Rapaport, TCA CROSS will be my first pick, I often combine this with very low density CO2. You may get some PIH given your skin type from the TCA but that can be reduced with HQ .2-3 sessions the re-evaluate for other procedures as described. 
Acne scar revision comprises of specialised procedures. For the best results, one should target the acne scar type with ideal treatments METHODS. Using one device is not optimal. As everyone has a unique pattern of acne scarring, the best solution is a tailored one.  The web reference below will take you to a resource to help you understand acne scar revision at a specialist level. I embedded all the videos in one page to help.

As an example deep ice pick scars, and narrow box car scars are best treated with TCA CROSS. Deep narrow scars respond better to this treatment than even the most expensive lasers. On the flip side, rolling, and atrophic acne scars can improve with fractional devices such as Fraxel, fractional lasers, ProFractional erbium lasers, Infiini –Intensif –Intracel radiofrequency microneedling. Atrophic scars (depressions) can be treated with either fat grafts, PRP or dermal fillers. Tethered and anchored scars are best treated with surgical techniques such as subcision. Other surgical techniques that I use include punch elevation, surgical elevation, punch excision and traditional excision for focal scars. Early and very mild acne scars respond well to eMatrix and non-energy microneedling, as well as vascular lasers. Skin colour changes such as PIH or dark marks respond best to sun protection, creams, and Q switch lasers in the nano and pico pulse durations.

The majority of patients will have a collection of different scar types, and hence a tailored treatment METHOD will be best. Careful examination, especially under angled lighting with scar mapping will give you an understanding of what are the best options for your scars. Additionally tactile examination namely touch will give me an understanding of the amount of subdermal fibrosis, as special equipment is needed for this sub-set of acne scars.  In the majority of patients its finding the correct combination that give you best results, and everyone is unique! It is never about the device, its about the specialist behind the equipment that will deliver the best outcomes. All the best, Dr Davin Lim. Acne scar dermatologist specialist. Brisbane, Australia.

Ice pick and boxcar scars, redness, and dilated pores. What is the best treatment for me? TCA cross and Infini? (Photos)

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