Thank you for your question.
You submitted 2 photos and you’re basically asking what procedure is best for acne scars,
enlarged pores, fine lines and tired looking skin.
And you submitted two good photos to help provide some guidance as to what your situation
is.
Well, I can certainly assist you with understanding how a physician strategizes the person’s
questions and problems like yours.
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 and helping people
rejuvenate their skin is something we get to do every day in our practice.
And this is a type of question where you are going to have so many different permutations
of answers because everyone comes to this from their own perspective and their own sense
of priorities as to what is the best way to address the issues.
So it is important when you meet with a doctor that you provide some guidance.
Now, it is understandable, very often people come to our practice and will say that they
have these types of issues and they’ll just say, “What do you recommend?”
So, I basically try to help by breaking down what the problems are that may have a single
procedural type of solution and what are the problems that require some ongoing treatment
and then on top of that, when it comes to the skin, maintenance is often a very important
strategic part of the overall benefit that you can experience after you meet with a doctor.
So, when you think about it, let’s start with the acne scarring.
Acne scarring is one of the most challenging problems in the aesthetic field and every
year, there are new light energy, energy-based devices, different ways that always claim
to be the best solution for acne scars and yet every year, more come out because they’re
not really as perfect as they claim.
And I think that is an intrinsic problem with that type of strategy is that an energy based
device or laser isn’t going to be a single solution but it can be a part of a solution.
So when it comes to acne scars, the reason why I start with that is that very often,
it is a challenge first to have a good strategy but it requires a proper diagnosis.
So when I evaluate patients who have acne scars, I take very detailed photos, I look
at them or examine with something called back lighting to look at the shadows that are the
result of volume loss in different levels of the skin.
It is important to diagnose the type of acne scar before you start with the strategy because
not all acne scars are the same.
There are ice pick scars, there are boxcar scars, there are rolling scars, there are
atrophic scars and with all of them, come certain strategy to improve them.
I’ve also noticed that there is a fair amount of freckling and sun exposure.
So with that comes other solutions that do include lasers as well as when you think about
the fine lines, the sun exposed skin, we think of skin that really needs some collagen.
So a strategy that we employ for patients in terms of collagen building is we use something
called platelet-rich plasma (PRP).
Platelet-rich plasma (PRP) is derived from your own blood and is a concentration of the
wound healing factors that are necessary when you have a cut.
Platelet-rich plasma (PRP) can be applied through injection.
It can also be applied topically after a procedure like microneedling.
Microneedling is a technique of using these fine needles to create fine little holes in
the skin intentionally to do 2 things: one is to create a wound healing response and
two, is to deliver something like platelet-rich plasma (PRP) as well as other topical active
ingredients to help improve the skin.
So, I think that it is important for you to get comfortable with a single physician who
can guide you with all of these different options.
There are certainly infinite possibilities but when I do a consultation with the patient,
I always know that it is also important to understand what their capabilities are in
terms of time and resources to allocate for all of the remarkable things we’re capable
of doing.
And so I try to help them reach a certain ideal endpoint that will be part of a journey
of continual treatment in order to get the optimal result.
One last part of this equation of course is skincare, skin products and things that you
can do at home.
So a system has to be developed that you understand what the treatment plan would be optimally
for you.
So it can include, as I mentioned, platelet-rich plasma (PRP) for collagen buildup and skin
quality improvement.
It can include laser whether it is fractional lasers, non-ablative lasers, non-ablative
fractional lasers.
You can also include microneedling, it can include also injectable fillers.
So there is certainly a lot of different options to consider and of course the use of topicals
including topical like retinol, sunblock and as well as good moisturizers and different
other and you can also add in peels for that matter.
So with that being said, a photo is a one part of the process but the real answers come
from proper examination and you need to become comfortable with the doctor who is going to
guide you throughout this journey.
Very often physicians and non-physicians are more about the transactions.
They have a new laser, they want to use that laser for everything.
If they have a new device or they have a single strategy that they apply to everybody, you
have to get the feel from the doctor you are meeting with and if you are comfortable, begin
your journey and hopefully you’ll reach a point where you feel like it was worth the
process.
So I hope that was helpful, I wish you the best of luck and thank you for your question.