Thank you for your question.
You submitted a photo of the cheek area and you are asking about getting an opinion of
comparing CO2 laser versus getting a Baker-Gordon peel to treat acne scars.
So, I think I can give a little bit of perspective and it’s probably going to be different
from what you are going to hear from a lot of colleagues.
I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic reconstructive
surgeon practicing in Manhattan and Long Island for over 20 years and I think I can that what
we can do is give you a little bit of perspective based on my my experience doing this for this
log, and my observations of what happens to skin over time.
With the photo you submitted it is clear that it appears that you are younger and that there
are multiple typical acne cheek scars.
Now one that thing I can tell you from seeing patients over the years is that the concept
that you are basically dealing with is that when you had acne, you lost volume of skin,
and so there are small depressions.
And those depressions are not just depressions but scar tissue underneath.
So one of the things that is done in acne procedures acne scar procedures is called
subcision where we actually place some type of special type of blade under the acne scar,
and release it because it’s not just the inflammation causes some scarring.
It is the depression or loss of volume in the dermis and there’s a band of scar tissue
underneath.
So think about it what are we doing when we do lasers or peels - we’re taking the adjacent
skin and making it more even with the more deeper skin in terms of the relative depth
of the acne scar.
In other words we are trying to create less contrast between healthy normal skin and acne
skin.
Now, it’s been my observation that with patients who have had peels in the past and
lasers in the past, especially when they’ve done multiple procedures, aggressive procedures,
not fractionated limited procedures, but aggressive procedures, the skin gets thinner.
And in many ways we’re effectively you are sacrificing good skin to match the depth and
continuity of scarred skin.
So in my practice when I meet someone like yourself, I start to explain to them that
there is never going to be a point where you’ll have perfectly smooth skin.
And it’s really not practical for someone who has suffered from this type of acne-type
of scarring, but rather we want to do is try take the attention away from the areas which
may draw somebody else’s attention, or draw the patient’s attention.
Now what we’ve been doing is we’ve actually been using platelet-rich plasma in combination
or with the hyaluronic acid filler to try to build up the skin under the scar, and try
to soften that transition, but rather than ablative method but rather by adding volume.
What we are looking at is a new concept of regenerative medicine.
Now of course fillers have always been around to help people with acne scars, but I found
that many patients who have chronic problems with acne scars and they bounce from doctor
to doctor, some offer lasers and do lasers, others offer fillers, but a lot of times these
patients are so frustrated they just keeping looking for one new solution after another.
So I always explain that if we are going to do something we have to be on some type of
plan so that we can really be strategic and intelligent.
Now I have that the use of PRP or platelet-rich plasma derived from your own blood softens
the scars, improves the quality of skin and with the combination of hyaluronic acid fillers
helped to plump up the skin.
And there’s been clinical studies for wound healing showing the synergistic and long-term
improvement based on more permanent what is called fibro-vascular ingrowth, which means
there is actual tissue that grows in as the hyaluronic acid disappears.
We treat everyone on a case-by-case basis.
But I think what I’m trying to say essentially, I would avoid any type of aggressive deep
peeling at a younger age, and see if you can try to regenerate and rejuvenate the quality
of the skin.
Because like I said, you can’t completely eliminate the scars, but you can improve the
skin quality.
And over a period of time with the right treatments, you can really reach a better place without
going through the trauma and long-term loss of very young skin.
It’s different as you get older but then things change in terms of facial volume as
you get older.
So I would suggest you explore this, explore this idea of regenerative methods using platelet-rich
plasma, hyaluronic acid fillers, subcision, and some ablation.
We sometimes combine this with limited fractional CO2 laser.
But I’ve tried to do whatever I can to maximize the skin quality before doing something ablative.
So I hope that was helpful, I wish you the best of luck.
Thank you for your question.