For one I have to disagree with you completely on the sugar/carb thesis. For your health you're absolutely correct but I ate almost none as a child and had genetic acne, period, cystic. Sugar/carbs had almost no bearing on it.

As for the recommendations by Rullan, they seem logical but I'm personally not experienced in that quatro or combined stuff. The aim is likely to smooth out (erbium), smooth/generate healing (phenol cross) and generate volume/healing (subcision).

It's extremely hard to know for sure the reactions/risks per person and also how each element will react. It seems a logical suggestion(s). I can say this for sure the scars definitely need various techniques or attempts, as they have different elements.

I think the puddle areas could risk subcision. Not familiar with fraxel dual erbium really, phenol cross seems to have had decent results from people who've combined it with other stuff. On the whole I'll let others comment who've had them or have more experience in them, but the recommendation doesn't seem atypical or anything.

Treatment target: lifting and trimming of edges. Good lifting procedures are Taylor liberator. Edge shaving methods are cross tca or phenol then fractionally abalting with erbium. Take some session. Dont ever begin to see results before you 5th session