You need many treatments of TCA cross and then peels + derminator for many months (or some other resurfacing technique.) You seem to have icepicks and shallow boxcars. The picture is not very clear and is actually so up close and bright that it is hard to see any rolling scars and scar edges, so I cannot say if you need subcision. Best of luck!

Dr Emer? HAHA - that would be typical. Mega session for the $$$$$$$$$$$. You need to baseline with all that filler, Intensif, and Erbium. What do I mean by that. Healing takes 3 months after one of those procedures. You had 3 at one time. The body does not heal like this. Drs do this for quick $$$$, swelling, and because people have no time to treat. I would space out procedures. Wait for a a month plus ( I would wait for a few)to see what happens. Then start treatments.

Subcision you would start with Dr Rullan in SD, or Dr Chris Zachary in Irvine (Dr Lim's Mentor - might be a huge laser Dr). This would be done on the larger pits (deeper ones). Subcision does well on pics that are aprox a pencil eraser depth (top) or pencil rubber it's called in the uk. Dr Rullan also does deeper acid peels FYI, ask him about this.

I see boxcars which would do well with the Intensif, Infini, Secret, Vivance, etc... You will need several treatments of this. As I recall Intensif one could take up to 6 treatments because of the lower power so be aware of that. This could be done at any local med spa after your subcision.

I see icepicks which need tca cross, several treatments to raise them. Erbium resurfacing does work but I prefer TCA peels which have much less side effects and work better if once does many of them or a deeper sedated peel with a DR, they are great for the textural aspects of acne scars. This should be the very last thing you do with treatments not the first. Medium strength peels can be done (a med spa as well) , It's only for texture.

I would never do filler to plump up the cheeks without subcision to the individual pits, especially first before all the work to raise the scars (sub and tca cross). If your a guy chipmunk cheeks are never good... They filled you up like that to hide the skin issues with swelling. I would never do this and one must wait for the swelling to go down. If your skin is majorly textual you will need the peels most over time (many treat over 3 years as they have time).

Thanks! This is all very helpful. The problem is that I can™t afford to have a lot of downtime, that™s one of the reasons why I decided to get the treatments all done at once...now I know there are no shortcuts

I took a week off from work and in the future, I can only afford a weekend here and there. Will that be enough to recover from a subcision?

@cautiouslyhopeful TBH I wouldn't worry about downtime too much. If it's a problem with your job then that's different. I would focus on what needs to be done to get results. If you look shitty for 2 days at work people will understand. When your scars look a LOT better it will be well worth it.

@cautiouslyhopefulSadly I just wrote a response you might be interested in on the lowest down time procedures, give it a read:

https://www.acne.org/messageboard/topic/374441-what-are-the-best-low-downtime-professional-treatment-options/

You could do subcision with Rullan on say a Thursday and slap some concealer or makeup on it on Monday if need be and be fine. Same thing with Dermastamping. Peels will have longer down time and more results.,

TCA Cross which is easier to cover with makeup (even though the icepick areas turn red after).

Your skin issue is textural. You might do a sedated phenol peel with Dr. Rullan or do complete resurfacing aka fully ablative using profractional erbium (this is not what you just had done with erbium they take off more layers), not fractional channels. This would give more results in a shorter period of time, and you could discuss using makeup to have less down time and treating with PRP to increase healing times.

RF Microneedling can be done with prp to increase healing times.

Of course all these things add to the cost of the procedures. More down time and more healing time equals more results.

Start with more sessions of RF microneedling, even at a local med spa. Do your Subcision with Rullan (3 of them are needed). Worry about tca cross and peels lastly.

On Realself when I posted my photos and question, Dr. Emer was the only one who really suggested filler (even Davin Lim said this would most likely not be necessary.) Emer said it was the FIRST thing that NEEDED to be done... if I got bellafill my cheeks would be lumpy. Not sure I agree with filler unless its one of the very last steps and done more as augmentation

54 minutes ago, Petsme said:

On Realself when I posted my photos and question, Dr. Emer was the only one who really suggested filler (even Davin Lim said this would most likely not be necessary.) Emer said it was the FIRST thing that NEEDED to be done... if I got bellafill my cheeks would be lumpy. Not sure I agree with filler unless its one of the very last steps and done more as augmentation 

What did lim suggest you do then?

Infini RF x 3, then subcise anything left 3 months after. Filler if needed at that point. 

Im starting with subcision 3x though because I'm on accutane and can't go Infini for a few months and the scars that bother me most are tethered. Then I'll do Infini after  don't think I'll need filler bc nothing is deep at all 

3 hours ago, Petsme said:

On Realself when I posted my photos and question, Dr. Emer was the only one who really suggested filler (even Davin Lim said this would most likely not be necessary.) Emer said it was the FIRST thing that NEEDED to be done... if I got bellafill my cheeks would be lumpy. Not sure I agree with filler unless its one of the very last steps and done more as augmentation 

 
Yeah, it is horrendous. I'm looking to have the filler dissolved soon. Its too much! I think he used 1 and maybe two syringes on my temples and upper cheeks. Any good surgeons in LA to recommend? I think I'm gonna stay away from doctors in Beverly Hills from now on. 

Agreed. Filler should be the last step after everything has been done. And even so, should be done conservatively! 

1 hour ago, Petsme said:

Infini RF x 3, then subcise anything left 3 months after. Filler if needed at that point. 

Im starting with subcision 3x though because I'm on accutane and can't go Infini for a few months and the scars that bother me most are tethered. Then I'll do Infini after  don't think I'll need filler bc nothing is deep at all 

Oh good. Let me know how your subcision go. I had Intensif but I heard Infini is better...

Just a clue... if any acne scar revision specialist does not know of the new guidelines released in JAMA 28th June 2017, regarding Accutane and safety profile, you may want to consider someone else. If a scar specialist is passionate about their work, and your outcome, they would be up to date regarding literature. Regarding INFINI and the INTENSIF debate, both have their pros and cons, Emer is correct in the 'robust nature' of the solenoid, but this only applies to less than 1% of extreme fibrotic scars. Hard to explain - but in a minority of cases fibrosis or thickening of collagen is so bad that the needles of many devices like Secret, Vivace, Infini etc... can not penetrate, but Intensif can. The flip side is that even if Instensif can go down to the required depth the PD or pulse duration is limited to 200 ms, and energy is non -insulated. Hence there is no one 'perfect device'. If you are not in a hurry, and your scars are more tethered and atrophic, break down the tethering vertically (Infini), and horizontally (subcision), then re-evaluate. What ever is left is truely atrophic, and hence why filler is last. Good choice with your strategy either way. (FYI looking at the scars, 30 G filling would only require 0.02 ml, so max you need would be 0.4 ml filler- rest should be used as 'displacement' to stretch atrophic areas aesthetically, without targeting the individual scars. Possibly why Lim would have used this last??? )

Also had a question on how permanent are these results from RF microneedling and subciscion. My skin is looking better these past two days but not sure if its because of the inflammation.

I used to microneedle at home too. My skin would look good for about a week and then would go back to its original state.

There is microswelling if you are so close to having just finished a procedure. In my opinion, you should wait 3 months after any procedure to judge its effectiveness. At this time, the results are "permenant." I use quotations because as you age, things may worsen due to natural collagen loss and sun damage.

the magic in skin treatment is the healing,its in the weeks/months after.