How can I get rid of these shallow boxcar scars? (Photo)

Question

I’ve done 6 sessions of microneedling after I finished accutane. However, I’m wondering whether I should try a different treatment for my scars or if I should just continue with the microneedling. I’ve certainly seen improvement although it’s not as dramatic as I’d like it to be. What type of lasers would be effective in improving my scars? I’m a little reluctant on ablative laser as I’ve heard it isn't suitable for darker skin. Do you think non-ablative lasers would be helpful?

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

Wanda Minnis-Dyson, MD · Answer

Bellafill filler would be a good choice for acne scarring. You can also consider excision by a dermatologist of each individual scar. Excision would be a long and tedious process

Nelson Lee Novick, MD · Answer

Subcision & TCA CROSS Are Simple, Relatively Inexpensive & Time Tested Acne Scar Treatments that have been shown safe for any skin type, including skin of color.  Subcision is for elevating and smoothing boxcar and rolling scars. TCA CROSS is for narrowing ice pick scars and dilated pores. Microneedling, which I have been performing for over two decades is really not an adequate monotherapy for acne scars, and it is best reserved for helping to better superficially blend the color and texture of treated scars (kind of like a "polishing" step) with the surrounding normal skin. Despite the marketing for its use to actually treat all kinds of acne scars, microneedling, as you have already found out, is seldom an adequate as a stand-alone treatment, so little surprise you have been disappointed in its use up to now. As for the bells and whistles fraxel laser and other energy-based devices, if you do your due diligence, you will find that the science to support their use lags far behind the marketing hype to promote them. So, "buyer beware."  Hope this helps. Best of luck.

Timothy Abrahamson, MD · Answer

Using the nonablative 1540 nm laser is a good option.

Depending on how atrophic, bellafill is another good option.

How can I get rid of these shallow boxcar scars? (Photo)

Answers (4)

Answer: Scar therapy on the face

Answer: Scar therapy on the face

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How can I get rid of these shallow boxcar scars? (Photo)

Answers (4)

Answer: Scar therapy on the face

Answer: Scar therapy on the face

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Everything you need to know about Laser Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.