Fraxel will not fix scars, it's about the scars ... treatment recommended not the machine.

Fat transfer works for some and not for others. Be aware it's expensive, you must be sedated, and it's not one and done, ... one must top up a few times after many months to improve the look. It can be lumpy if not topped up to make it look good, and it really depends if your body absorbs it or not. There is not definite with that. If you gain fat in your face / body, the graft will also if it takes after 6 months. Micro injections are better than big blobs.

Personally I would do HA filler first, and see if you even like it, the look, how things heal, etc. Then go for fat or Bellafill if it's something that works for you as a treatment. Permanent is never a good place to start.

HA is not a foreign object, it's naturally found in the body.

Some need fat transfer and then surface HA injections to fill smaller spaces. As we age we loose bone / fat so it's not forever. But it "can" be long lasting, depends on your body.

Fat is good for mass fills of the cheeks, not good for thin areas or smaller pits, this is where HA shines with subcision as a spacer.

It again depends on your scar types, I would consider fat for deep pitting or wide fat loss, but not small acne scars.

Agree with the above. If you have significant volume loss due to acne scarring, then fat transfer can do the heavy lifting and revolumize the face. Then you can fine tune the remaining scars with filler. Using fat superficially is not a good idea because it does get lumpy and is hard to get rid of if you do get overcorrected. Like BA said, the idea of permanent sounds great until you get unlucky with picking a surgeon, and they overinject. Then it's a nightmare to try and reduce it.

In general I like fillers that are "you see what you get." That means if you inject 1 syringe, you'll see one syringe of correction. Stuff like Sculptra, Bellafill, and Silikon all work by stimulating collagen (it's really scarring) that helps to fill up the indentations. You can't predict how much volume it will generate, and you could get lumps if they're injected too superficially. Fat is also unpredictable in that sense.

Once again BA has wrapped up the view of most specialist in peer reviewed journals (from what I have read). Fraxel is not a good solution for anything more than superficial pitted scarring or early scarring. Subcision is the more sensible choice as most scars have tethering or at least abnormal collagen formation in the deeper dermis (out of reach by Fraxel NA 1550 or even the CO2 RePair). Fat. Well, for patients with MARKED volume loss, yes, it can augment scar revision by replenishing volume- especially good in the older age group. Most specialist will say you need 2 sessions as re-absorption of fat is predictably unpredictable. HA fillers are the way to go - many new paper confirm the longevity beyond 'aesthetic filling ' especially if combined with subcsion during the same procedure. OK, so new ways of fat harvesting, -the promise of stems and the Tulip system. Well, for years the Italians have known that gentle harvesting of fat preserves the stems, improving scars, and skin texture, so the Tulip system (Buzz trend) copies simple harvesting then 'distillation' of fat and stems. Promises a lot, however from what I have heard still can give lumps (even in the best hands of plastic surgeons who have trialled this system in the context of acne scar revision). It does not give the finesse of HA. Totally agree with BA - not against fat, just how its utilised. I wish you well.

Be aware that fat grafting can be very clumsy, so to say, it's hard to get it right as the fast will change with time. So find a good doctor.

A friend of mine had before some years fat transfer on scars without subcision.He saw results only for 1-2 months and after that scars were the same.So,should his doctor subcise that scars first or it doesnt matter?

@tasinhoYes you have to subcise if they are pits when using fat. Again you can't just do one treatment, ... you have to top up as needed to get the desired look (4 times). Doesn't work on smaller scars as said above.

I did subcision with nano fat grafting. Looked good initially then scars came back after a few months. Subcision with RF micro-needling followed by a HA filler is the way to go.

I did micro fat injections with subcision this January. With the good doc. No result from the beginning. All dissolved in 3 months completely. The fat is for indented areas not the individual scars. The absorption rate depends on your body.

Yes, Nano fat grafting especially with the Tulip method promises a lot but has a high failure and or complication rate. Fat, as everyone knows is unpredictable. Most specialist will say you need 2 sessions, if one insists on 'autologous' and not synthetic methods to treat atrophic areas. The current research is on dermal and fat transfer using new methods. This involves the actual transfer of fibroblast to the atrophic area, as well as fat - very different from 15 years ago where by grafts were taken from behind the ear and placed in to scars via incisions. Research is still new, and results will be out in probably 2 years regarding the longevity and success and or failures regarding this treatment. Subcision with HA filler is probably the most predictable and safest procedure with the highest satisfaction rate for rolling combined with atrophic scars, in the correct hands.