Thank you for your question.
You submitted several photos showing the extensive nature of your acne scars and you provide
terrific detail in timeline that started 10 years ago of all the different things that
you’ve been doing for your acne scars starting with microdermabrasion, fractional CO2 laser,
the use platelet-rich plasma (PRP) and microneedling, dermabrasion, punch grafts and now currently
using venus viva which is a radio frequency device which employs the use of micro needles
that are penetrating the skin to generate collagen stimulation through the induction
of heat.
And so you are asking and it is clear that you are frustrated that having done so many
things and looking for guidance to what to do moving forward.
Well, I can certainly give you my perspective on your situation.
I treat a lot of patients with acne scars.
I’m a board certified cosmetic surgeon and a fellowship trained oculofacial plastic and
reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years and certainly
the frustrations with dealing with acne scars is something that I’m familiar with and
I do spend a lot of time counseling people like yourself as to what to do on how and
what to expect.
It’s clear that you are patient and committed and you are doing literally, you have experience
in many ways the textbook on how to deal with acne scars.
I think that you are at least embracing, including this recent treatment, is that there isn’t
ever evolving improvements in the laser and radiofrequency technologies with the ultimate
intention is to stimulate collagen.
And just as a review, you understand that when you had inflammation and you had the
cystic acne that ultimately led to these scars.
What automatically happened is you lost skin and so when you look at a profile at some
somebody who has acne scar, they have ice pick scars, they have rolling scars, they
have boxcar scars and basically different ways to describe lost collagen.
The presence of scar tissues and the complexities of trying to restore volume is always individually
determined.
On top of that skin type, some skin is more amenable to certain types of treatment versus
other skin types.
Now certainly, I would say that there is a common thread in all these treatments and
the common thread is building more collagen.
There is loss in collagen and the goal is to build more collagen and certainly heat
induction is a way to accomplish that.
I would say that in my practice, one of the things I would probably add to your regiment
even though you had experience like what you did where you did the microneedling and platelet-rich
plasma (PRP), is that I find that use of platelet-rich plasma (PRP)as a injection within the scars
as well as combined with subcision of the scars.
Subcision meaning going underneath the skin where there is adhesion with the underlying
skin and releasing those scars.
There is a certain amount of value in trying to improve and remodel the nature of the scars
and so platelet-rich plasma (PRP) has had value in my practice.
I also combine platelet-rich plasma (PRP) with injectables.
You know I think one of the things that is a particular challenge is how much collagen
can you induce with all these modalities.
Your skin has definitely heated more than a few times.
It has been needled multiple times.
You have to ask yourself where the reserve is , how much collagen can be generated.
So in my mind, before I do a laser device, we have several lasers in our practice that
would be useful and even lasers for people with darker skin where we can control the
amount of heat that’s applied and get a lot of these improvements accomplished but
basically what I try to do first is prep the skin, condition it.
Now for a lot of colleagues who are dermatologists, that means the use of retinoid, that means
basically treating the epidermis.
What I find also of value is the injection of platelet-rich plasma (PRP) into the skin
as well as under the skin.
I think that improving blood supply, collagen and help soften the scars preps the skin in
a way the probably improve the result of any modality.
I think that it is very important for patients with acne scars to understand that there is
no ideal.
There is never time that you will not have any signs of having cystic acne the way you
had but there is a continual aspiration or pursuit of improvement.
And as in many areas of cosmetic dermatology, there is a continual assessment made of treating
and observing results.
So, I think that you are certainly on a good track when you are having this additional
treatment and you understand there is time that is involved in seeing results of any
collagen inducing treatment.
There may be some value in the use of a fractionated erbium laser with the shorter pulsations to
help with the resurfacing.
The reason I choose that because it has much less heat dispersion and is less likely to
cause reactive hyperpigmentation than hyper inflammatory pigmentation which means typically
we will prep somebody with bleaching cream or hydroquinone type of treatment before hand.
There are many ways to treat acne scars.
Once you complete your current treatment and you may want to step back and just think about
comparisons of where you were 6 months from now.
Don’t go back 10 years because 10 years is a long term and other facial aging changes
occur.
A lot of my patients who are a little bit older will have had acne scars and then those
acne scars look actually deeper when the skin gets loose and when I actually lift their
face, it actually looks better when they have face lift operations.
I’m not recommending that to you but I’m just saying that instead of going for percentage
description of improvement, compare what you look like before most recent treatment and
whenever your doctor states is likely the end point of the plateau and see if there
is improvement and then come up with a plan.
I explain to my patients that if you had acne scars, you don’t expect any time to have
a single treatment or single modality.
It’s always a combination of treatments and ways to try and maximize results and it
is very subjective.
So, it requires a good strong dialogue relationship with your doctor to feel comfortable otherwise
you, like many other people, find themselves bouncing from one practitioner to another
or finding one device versus one another and you look at devices all claim the same thing:
improvement of wrinkles, improvement of scars, generating collagen and it leaves people who
are the recipients of all these barrage of information often very confused.
So it does take a dedicated beauty doctor to help you navigate and navigate these options.
So I hope that was helpful, I wish you the best of luck and thank you for your question!