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Stubborn Acne Scar: What is the Best Treatment?

What is the best treatment for acne scars?

Acne scar management requires proper evaluation and clear communication about expected outcomes and long term strategy. It’s very important to understand that one
strategy for acne scars doesn’t apply to everybody. And it’s not usually a single
one off process where we do one thing and then you’re done. When you seek
opinions from doctors regarding acne scar treatment keep in mind that you
will get different opinions. Because there is more than one way to approach
these issues. Practitioners make recommendations based on a perspective
of experience. And often whatever is the latest branded device they’re currently leasing.

I’ll discuss the steps I take in evaluating a patient with acne scars. And
how I make my recommendations and set expectations.
I’m Dr. Amiya Prasad. I’m a Board-certified cosmetic surgeon and
Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in
practice in Manhattan and Long Island for over 20 years. I perform a wide range
of procedures for patients with acne scars. Including lasers, use of
radiofrequency technology, skin boosting, regenerative medicine technology such as
PRP or platelet-rich plasma, and a cellular matrix as well as acne surgery
such as subcision, scar removal, and skin grafting. When I look at a patient with
acne scarring I take high-resolution digital photos.
And I also take photos with the method called backlighting. To look at the
shadows which provide me with information about the depth and extent
of the scars. Acne scars are typically classified as rolling scars Boxcar scars
and ice pick scars. There are different levels of all these
scarring and a strategies developed based on these specific classifications.
When you’re dealing with acne scars you are dealing with one common issue. Tissue
loss the underlying strategy is to maximize the volume where tissue is
deficient. And to blend the interface between the normal skin and the adjacent
area of tissue loss. Unfortunately many people with acne scars literally jump
from one laser to another based on aggressive marketing. Resulting in
frustration and disappointment. A very important limitation is the generally
accepted standard amongst ethical professionals. As to the maximum level of
change that can occur with acne scars. Generally speaking improvement of about
20 percent followed by maintenance procedures is a realistic expectation. Of
course the term twenty percent can be up for subjective interpretation. For my
patients I find that defining success as an improvement avoids unrealistic
expectations. My approach to acne scars is comparable to my approach with facial
aging. I create a customized strategy to work from the inside outward. For example
if the cheek volume can be enhanced I will place a long-lasting filler such as
Juvederm Ultra Plus or Juvederm Voluma at the bone level. The improvement in
projection can have a significant effect on softening the appearance of acne
scars. This becomes particularly relevant with the natural progression of facial
aging. I also see how improvement in volume and facial balance can shift
focus away from the acne scars at the skin level. Although it is commonly
accepted that various lasers can help depress cars by controlled injury which
then stimulates a healing response by cells
in the skin called fibroblasts to produce collagen. The question is how
much of a difference can be achieved when the tissue is scarred? In addition
how much collagen generation can occur when the patient has had one or more
previous laser radiofrequency or micro needling procedures?
I find myself consistently integrating the use of PRP or
platelet-rich plasma. To induce collagen production without causing any
significant injury as a first-line before or in conjunction with non
ablative laser treatment. PRP or platelet-rich plasma not only stimulates
collagen production but also improves blood supply and softens the scar tissue
in particular for patients with Boxcar scars. I find this strategy useful. I
routinely combine PRP with hyaluronic acid filler. Which is delivered to the
dermis using a procedure called skin boosting. Rolling scars and scars
associated with the lack of underlying fat are often managed through a
combination approach. Procedures such as subcision injectable fillers are placed
on the bone level below the skin and in the dermis that combination can be very
effective. There is also a type of ablative laser technology often
beneficial particularly for Boxcar scars. These are scars with very sharp defined
edges. Generally when using a laser we try to soften the edges of these scars
and then blend the skin so that the skin heals smoothly for improvement.
Another approach which is more convenient and beneficial particularly
for shallow scars is water-based microdermabrasion. Or a procedure that
has called HydraFacial there is no downtime and the improvement in the skin
can be appreciated immediately afterwards. I recommend that any
therapeutic strategy for acne scar involve regular follow-up examinations
and some maintenance. Procedures which are customized to the individual in a
time where devices get aggressively marketed and unrealistic expectations
are promoted, it’s more important than ever for you to find a physician who you
trust. To have your best interest at heart all
too often new devices come on the scene and many doctors buy or lease these
devices. And then think only about the profit from the transaction and have no
interest in a long-term management plan. I recommend you meet with experienced
doctors and make sure you feel that you are being well informed and you have
confidence in the doctors treatment plan for you. And what the short-term and
long-term outlook will be. I hope you found this information helpful. Thank you
for your question.

Acne scar treatment requires thorough evaluation as well as clear communication about expected outcomes and long-term strategy. It’s important to understand that one acne scars treatment strategy does not apply to everyone, and it’s not usually a one-time process in which we do one thing and you’re done. When seeking medical advice on acne scar treatment, keep in mind that different doctors will give you different advice because there are multiple approaches to these issues. Practitioners make recommendations based on their experience and, in many cases, the latest branded device they are currently leasing.

Acne Scar Treatment at Prasad Cosmetic Surgery NYC and Garden City

I’ll discuss the steps I go through when evaluating a patient with acne scars, as well as how I make recommendations, and set expectations. For patients with acne scars, I use lasers; radiofrequency technology; Skin Boosting; regenerative medicine like PRP or platelet-rich plasma, and Acellular matrix; as well as acne scar surgery like subcision, scar removal, and skin grafting.

When I examine a patient with acne scarring, I take high-resolution digital photos as well as photos using a technique called backlighting to examine the shadows, which tell me about the depth and extent of the scars.

acne scar evaluation
acne scar evaluation at Prasad Cosmetic Surgery NYC and Garden City, New York

Acne Scar Treatment Before and After

acne scar treatment before and after at Prasad Cosmetic Surgery Manhattan, New York City
acne scar treatment before and after at Prasad Cosmetic Surgery Garden City, NY
acne scar treatment before and after at Prasad Cosmetic Surgery New York City, NY
acne scar treatment before and after at Prasad Cosmetic Surgery NYC
acne scar treatment before and after at Prasad Cosmetic Surgery Long Island, Garden City
acne scar treatment before and after at Prasad Cosmetic Surgery Garden City, New York

What are the Different Types of Acne Scars?

types of acne scars illustration

Acne scars are typically classified as rolling scars, boxcar scars, and ice-pick scars. There are different levels of all of these scarring, and a strategy is developed based on these specific classifications.

How to Deal with Acne Scars?

When you’re dealing with acne scars, you are dealing with one common issue — tissue loss. The underlying strategy is to increase the volume of deficient tissue, and blend the interface between normal skin and the adjacent area of tissue loss.

Unfortunately, because of aggressive marketing, many people with acne scars jump from one laser therapy to another, resulting in frustration and disappointment. A very important limitation is the generally accepted standard amongst ethical professionals as to the maximum level of change that can occur with acne scars. Generally speaking, an improvement of 20% followed by maintenance procedures is a realistic plan. Of course, the term 20% can be up for subjective interpretation. For my patients, I find that defining success as any improvement avoids unrealistic expectations.

fillers for acne scar before and after treatment
fillers for acne scar before and after treatment at Prasad Cosmetic Surgery New York City, NY

My approach to acne scars is similar to how I approach facial aging. I develop a tailored strategy that works from the inside out. For example, if I can increase cheek volume, I will use long-lasting fillers like Juvederm Ultra Plus or Juvederm Voluma at the bone level. The improvement in projection can help to soften the appearance of acne scars significantly, which is especially important as the natural aging of the face progresses. I can also see how improvements in volume and facial balance can draw attention away from acne scars.

At the skin level, it is commonly accepted that various lasers can help depressed scars by controlled injury which then stimulates a healing response by cells in the skin called fibroblasts to produce collagen. The question is, how much of a difference can be achieved when the tissue is scarred? In addition, how much collagen generation can occur when the patient has had one or more previous laser, radiofrequency or microneedling procedures?

PRP for Acne Scar

before and after prp treatment for acne scars - female right cheek
before and after prp treatment for acne scars - female right cheek

As a first line treatment before or in conjunction with non-ablative laser treatment, I consistently incorporate the use of PRP or platelet-rich plasma to induce collagen production without causing significant injury. PRP, or platelet-rich plasma, stimulates collagen production while also improving blood flow and softening scar tissue. I routinely combine PRP with hyaluronic acid filler, which is delivered to the dermis via a procedure called skin boosting, for patients with boxcar scars.

Rolling Acne Scars Treatment

Rolling scars and scars associated with a lack of underlying fat are often managed through a combination approach. Procedures such as subcision, and injectable fillers placed on the bone level, below the skin, and in the dermis are very effective.

Laser for Acne Scars

Laser for Acne Scars before and after
There is also a type of ablative laser strategy often beneficial particularly for boxcar scars which have very sharp, defining edges. Generally, when using a laser, we try to soften the edges of these scars, then blend the skin so the skin heals smoothly for improvement.

Microdermabrasion for Acne Scars

Another approach, which is more convenient, and beneficial particularly for shallow scars is water-based microdermabrasion or Hydrafacial. With Hydrafacial, there is no downtime, and improvement in the skin can be appreciated immediately afterward.

I recommend that any therapeutic strategy for acne scars involve regular follow-up examinations with some maintenance procedures, which are individualized.

acne scars PRP treatment before and after, procedure done at Prasad Cosmetic Surgery NYC
acne scars PRP treatment before and after, procedure done at Prasad Cosmetic Surgery NYC
Conclusion

In an era when devices are aggressively marketed, and unrealistic expectations are promoted, it is more important than ever to find a physician you can trust to act in your best interests. All too often, new devices enter the market, and many doctors buy or lease these devices, only thinking about the transaction, and having no interest in a long-term management plan. I recommend that you consult with experienced doctors to ensure that you are well informed and confident in the doctor’s treatment plan for you, as well as the short and long-term outlook.

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