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.