Thank you
for the question.
You submitted 2 photos and you state in your question that 8 years prior that you had severe
cystic acne.
You took Accutane for 6 months and you state that you are now left with multiple pitted
scars as well as some hard scar tissue below the skin.
And you are looking for some guidance on how to improve your appearance and you are not
interested in fillers.
Well, I can certainly give you some guidance as to how I approach patients like yourself
and acne scar situations in general in my practice.
A little bit of background, 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 have essentially a full series of options that are available to my patients that I ultimately
customize to each individual’s needs.
We treat a lot of people with acne scars.
Now you made one specific statement, you don’t want fillers.
So if we take fillers off the table, it is with understanding that you are restricting
some opportunities with the use of traditional fillers.
A lot of times people come to us with the same request and there is a variety of reasons.
Very often it is because fillers are expensive and two is that they just have a challenge
with having the time to come in for those treatments in reference to just having the
time to come in for fillers.
So to begin with, understanding the different types of acne scars helps guide any doctor
in how to optimize the results of patients with acne scars.
So to begin with, we will start with where fillers actually fit and what we use as a
fillers substitute.
When it comes to acne scars, a type of scar called rolling scars and atrophic scars are
best managed with fillers.
These are the scars that appear to improve when you pull the skin and stretch and they
soften up which means there is room to work with underneath.
When someone has that type of situation and they understand that although they don’t
want fillers but they want volume, the options that we provide them include fat grafting
which means harvesting fat from one place and placing them in the face and under the
skin within the skin, as well as platelet-rich plasma (PRP), platelet-rich fibrin matrix
(PRFM).
Very often because of logistics, people choose platelet-rich plasma (PRP), platelet-rich
fibrin matrix (PRFM) as the first line because fat grafting is a surgical procedure and does
require a certain amount of operating room time.
What we do with platelet-rich plasma (PRP) and platelet-rich fibrin matrix (PRFM) which
just to give you a brief explanation, this derived from your own blood so for people
who want something all natural, well it couldn’t be more natural than coming from yourself
but from your own blood, we are able to concentrate the growth factors and the healing factors
that naturally stimulates collagen procedure as part of the healing process.
And when it comes to scar tissue, improving vascularity and blood vessels is also a benefit.
We’ve used platelet-rich plasma (PRP) for acne scars as well as to soften scar tissue.
Platelet-rich fibrin matrix (PRFM) is a little bit different and that it’s PRP that is
activated so that it is made into like a gel and that gel acts like a time release capsule
so that it allows even more growth factors and other things to be released in a specific
way so you get both the correction short-term from the gel and you get some correction from
the replacement of that gel with your body’s own tissue.
It is not the same as getting hyaluronic acid fillers but certainly it is something that
is palatable for people who don’t want fillers.
From the other side of that comes what we can do to help release any scar tissue and
that’s a procedure called subcision and that’s basically releasing scar tissue from
underneath the skin and letting the skin elevate providing room for platelet-rich plasma (PRP),
platelet-rich fibrin matrix (PRFM).
Lastly, there is some type of ablative strategy that is often beneficial particularly for
boxcar scars.
These are scars that have very sharp defining edges and generally, when doing a laser, we
try to soften the edges of those scars and then blend the skin so that the skin heals
smoothly and there is improvement.
Last of course, there is also acne surgery.
Scars can also be excised and sutured and closed and then the healed area can be lasered.
This is a strategy that takes several months to actually execute.
You don’t necessarily do everything at once.
You don’t get everything done at once.
And as is with especially with the field of regenerative medicine, you treat, you observe
and then you strategize.
So, it’s very important that you identify a doctor that you are comfortable with and
you are willing to work with and who is willing to work with you with these stipulations that
you don’t want any injectable fillers.
That being said, once you find a doctor, you will get an understanding of the level of
expected improvement.
And for yourself and the doctor, define what is success.
For me, I always try to help patients define success simply by one word - improvement.
If there is improvement, that is success and we work together to try to maximize that improvement.
If you want to have something that is simply unrealistic which I doubt then you will end
up disappointed.
But if you want to see improvement and you want to see the particular scars that really
bother you improve, bring that to the attention to the doctor and move forward from that point
on.
So I hope that was helpful, I wish you the best of luck and thank you for your question.