Skin texture/scarring - how can I improve this? (Photos)

Question

I’ve had every procedure done. A CO2 ablative laser, microneedling, microneedling with PRP, microneedling with some electric shock, tca peels, light peels, other laser treatments, fillers, fractional skin resurfacing. I don’t know what else to do. Please help.

Anil R. Shah, MD · Answer

Hello! My name is Jessica, I am a physician assistant, and one of the providers at Aesthetic Skin - Winnetka & Chicago. This is a great question. It sounds like you've been incredibly committed to improving your skin texture and scarring—especially given the extensive treatments you've tried. When someone has undergone a wide range of procedures like microneedling (with and without PRP), chemical peels, multiple lasers, and fillers, and still isn’t seeing the results they want, it can feel deeply discouraging. But one powerful option that may still offer meaningful improvement—if done strategically—is full-field ablative CO2 resurfacing, or a more aggressive fractional CO2 laser treatment, assuming previous ones were lighter or fractionated at lower settings. Unlike non-ablative or fractional treatments that leave some skin intact, full-field ablative CO2 laser resurfacing completely removes the outermost layers of the skin and triggers intense collagen remodeling. It's particularly effective for deep acne scarring, etched-in lines, and uneven texture. I hope this helps and best of luck!

Raffy Karamanoukian, MD, FACS · Answer

Fractional laser is an amazing and highly effective treatment in our office. We use the laser treatment to help with acne scars, large pores, fine wrinkles, tissue collagen loss, scars, sebaceous hyperplasia, active acne, and for brightening dark pigmentation. Although there are very strong fractional lasers such as CO2 laser, we use lighter treatments for corrective skincare and maintenance of results. Our Thulium fractional laser, clear and brilliant laser, and Ultra Thulium laser are excellent options in our clinic. We also perform CO2 fractional and erbium depending on skin tone and tolerance for downtime. Patients do have to use a Melarase cream before and after treatment to help further reduce pigmentation after laser.  Melarase AM, Melarase PM, and Melapads can seriously improve surface sun damage and UV related pigmentation. Dark spots can improve with these treatments. I recommend fractional laser for incisional scars as well, especially after plastic surgery.  
Best,
Dr. Karamanoukian 
Realself100 Surgeon

Anna Chacon, MD, FAAD · Answer

Improving skin texture and scarring can be challenging, especially if you've already undergone a variety of treatments. Here are a few additional options and considerations that might be beneficial:

Combination Therapy: Sometimes, combining treatments can enhance results. For example, pairing laser treatments with microneedling or chemical peels can sometimes yield better outcomes than using a single modality.

Subcision: This is a minor surgical procedure that can help release fibrotic strands under the skin, which can improve the appearance of certain types of scars.

Radiofrequency Microneedling: This combines microneedling with radiofrequency energy to stimulate collagen production more effectively, potentially improving skin texture and scarring.

Topical Treatments: Consider using topical retinoids or other prescription-strength creams that can help with skin turnover and texture over time.

Consultation with a Specialist: It might be beneficial to seek a second opinion from a dermatologist who specializes in scar treatment. They may offer insights or newer treatments that could be effective.

Patience and Maintenance: Skin remodeling takes time, and maintenance treatments may be necessary to sustain improvements.

Each individual's skin responds differently, so a personalized approach is crucial.

Leonard Grossman, MD · Answer

In order to get a proper answer, a detailed history needs to be obtained, such as history of smoking, any prior illness, levels of estrogen, in your body and sun exposure. Depending on your age and levels of estrogen, and estrogen cream may be very helpful. Using Retin-A to stimulate skin regeneration will be helpful as well. To summarize you really need to see someone with a good reputation who will evaluate your skin, medical history,and your needs.

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