Hiya
Long story short I have suffered from acne since my late teens. It became progressively worse (severe acne) to the point that in September 2012 I started a ten month course of Roaccutane. I was on 70mg for approximately four months. Despite suffering from a number of gruelling side effects, and by no means has my acne completely disappeared, it is much better than hitherto. I have somewhat come to accept my acne scars and concede that no matter how much or what treatment I undergo, I will always have some scarring. And that's cool, because scars show you have a bit of history! Anyway, I am now at the stage where I want to at least try and reduce their appearance. I have done some research but there are myriad techniques which doesn't really help much in finding the appropriate treatment. For instance, I have read that laser treatments are regarded as dangerous whilst the results from peels are negligible. I recently had a consultation and was recommended six and possibly six more sessions of microdermabrasion (this previously said dermabrasion until I realised that it was MD). Is this treatment effective for my scarring? I was told that I have ice pick scars but I thought that I had rolling and boxcar scars which has confused me slightly. Are subcision and filler treatments best for rolling and boxcar scars? Could the TCA or Fractional/Frax methods work for me? I must also add that my skin is quite sensitive.
I hereby include pictures of my acne scars in the hope that someone will be able to offer me guidance in terms of the type and severity of my scars and possible appropriate treatments.
Any help is much appreciated
Antonio
I have added some new photos under the cruelest lighting! Most of these photos are taken of my left temple/cheek as that is the worst affected area. The bottom two photos are of the greatest resolution.
6 treatments of dermabrasion? Who is this that you are going to?
You might be confusing dermabrasion for microdermabrasion. If they are trying to sell you microdermabrasions, that will do jack for scars and they are trying to take advantage of you. I've had TRUE dermabrasion, and it is a very bloody, extreme surgical procedure. It's not to be taken lightly at all. However, for some types of scars, I can say that it definitely works BUT in very select cases. However, the recovery is very hard and extensive. You have to be mentally prepared for it.
It would not be the first procedure I would pursue coming right out of the gate. Based on your pictures, your acne scars are shallow and not bad at all. The pictures are a little blurry, but I think you are correct, I'm not seeing ice pick scarring. I see more of the rolling type scars, which may benefit from subcision. Do you have better pictures? Fractional co2 lasers may work, but people have conflicting views on it. Although a lot of the negative voices come from people who have not actually had the procedure. Refer to Inspired, Dragz, and Collegeboy84 for first hand accounts of co2 laser.
Hi BlahBlah, thanks for the response!
Indeed I think you are correct as I have just looked at the consultation notes and it says MD. I assume that means microdermabrasion? In that case I have been researching the wrong treatment for hours! Though yes it is six treatments of MD to begin with alongside other skin products. I will try a different camera in the morning in order to get some better photos. Is subcision a treatment that is routinely offered by clinics? In honest I have not seen it on any website treatment list, though it might come under a different name? I have done some research on fractional co2 but I am not sure if my budget can stretch that far especially if multiple sessions are required. Then again I might only need one or two sessions to see improvements which obviously I would be very happy with.
Okay, I'm almost certain that they were talking about microdermabrasions. Any clinic that recommends microdermabrasion for acne scars is not a reputable clinic. They are counting on the patient being misinformed. Dermbrasion involves sanding the skin down to the level of the upper reticular dermis, which is incredibly bloody. For reference, if you imagine the skin of a typical person's cheek's is around 1.5 microns (1000 microns = 1 millimeter), a dermbrasion procedure can be well over 400 microns if done deeply. By comparison a microdermabrasion is like polishing the skin, and takes off about 5 microns. That is like scrubbing your skin really hard with a brush. Not going to do jack for scars.
Microderm would do nothing. Just had it done yesterday but not for scarring. I had it done as part of my facial just to enhance product penetration. I have had a slight change in my scarring from dermarolling. I think that because your scarring is so localized and really not bad at all I would try non-invasive treatments and just use good skincare products. Your skin looks good to me!
Thanks! Though I do not think these pictures are a true reflection. I can see where you are coming from with regards to localised scarring. The scars form a crescent stretching from my temples to mid cheeks. I should get a dermaroller as you suggest, particularly as it can be done within the home!
You have a few boxcar scars and mostly icepicks, But your scarring is mild & don't think you need subcision as it does hardly nothing for small icepicks & you could risk more scarring by doing subcision if the Surgeon isn't careful. boxcars has minimal effects, But Subcision is mostly used for deep rolling scars that are tethered down on the skin. You should look into getting a dermaroller and doing it a home. Go to owndoc.com & check others for references on their improvements. Dermarolling is just as good as any laser in my honest opinion when it comes to treating superficial scarring, ice-picks & boxcars and plus you'll save a lot of money in the long run.
I personally don't like TCA Cross(yes it's cheap to do) as that is too risky and could make your scars wider as many have had bad experiences from it. If you claiming you have sensitive skin, Then I'd definitely stay away from it. Lasers work well for some & do basically nothing for others. I have read some you have had 6-10(or more) Laser treatments over the years and yet still have no results(no improvements) to show for it and yet at the same time lost several thousands of dollars in the process. If you have sensitive skin I wouldn't go that route either plus you are a lot more at risked getting hyperpigmentation down the road anytime you go out in the Sun. So if your an outdoor person & like going outside to have fun, I would avoid Lasers & just stick to Derma-rollers.
You could try to do a test on some boxcar scars to see if a filler can work for you, But please don't let any Doctor try to con you or have one of his representatives sell you a laser package of 4 or more with special discounts as most times they don't look out for the customer and more in it for themselves and having a fatter wallet.
Hi Ceyela, thanks for the advice!
I have added some more detailed photos at the top of the page if you are interested. It seems like I might have a combination of two scar types then. Do you think that the dermaroller would be sufficient to penetrate these scars in order to create new collagen? My only concern with using a dermaroller would be the lack of tangible results, though I definitely should give it a try. I think the main problem if I were to undergo laser treatment is that it could possibly damage much of my healthy skin as all the skin needs to be resurfaced. Well I think that's how it works anyway. What about microdermabrasion, do you think this form of treatment would work for my scars? On your last point, I do intend to at least see three specialists and visit my long term dermatologist for an alternative opinion.
Thank you for the new pics... Even in harsh direct sunlight, your scars are not bad. Of course photos don't always fully capture reality, but def not bad. I think you should do milder treatments like dermapen / dermastamping. I really don't think you need anything super aggressive.
I highly doubt microdermabrasion will help you at all so don't waste your time or money on it. Personally from what I've read it doesn't help the majority who have gotten that treatment so don't let these Doctors convince you otherwise . Please remember they are in Business to sell you things so they don't always look at it for your own benefit as they are in the business to make money. If you do your research here or go to realself or um google even most Doctors would tell you micro-dermabrasion is useless for acne scars.
Yes you do have 2-combination of scars, But mostly ice-picks and those are the hardest to treat. Dermarolling is a very slow process so don't be discourage if you don't see results right away as it takes a lot of time (Maybe a few Months to even years to see some results) as some People get better results than others. There is no guarantees it's going to work and nothing is 100% in curing acne scarring, So please remember we are after improvement not perfection. Dermarolling will create collagen and you can also look into derma-stamping and dermapen too. Look into owndoc as they do sell these on there(well not dermapen) and also have a video demonstration how to used it(dermaroller) on your face. Also they sell copper peptide to help with Collagen too.
Hi Blahblah and Celeya. Thanks for the advice and sorry for the late reply. I have been on holiday for a while!
Between September and December I will be abroad studying so for now I have decided not to commence any intensive treatment that will require me to stay in the UK. However, I am going to purchase a Derma Roller to begin with (and so I can do it abroad). Do you reckon I will see more improvement with a Derma Roller than twelve sessions of micro-dermabrasion? Also, could you recommend an appropriate needle length for my type and depth of scar. According to Amazon there are three models:
0.5mm Deeper Acne & Facial Scars & Wrinkles
1.0mm Very Deep Acne & Facial Scars & Wrinkles, Light-Medium Stretch marks & Cellulite
1.5mm length needles which are suitable for deeper Stretch marks & Cellulite
2.0mm
Also, is there a reason why the products on owndoc are almost are a fraction of the price than those on Amazon and other websites. Do you need all the other products and creams which come with a roller package? I assume the basics are the Derma Roller, alcohol-based disinfectant and post solution to improve results? Has anyone used Dr. Roller or ZGTS before? Maybe a Derma Stamp is better?
Thanks
Your (few) ice pick scars could be helped by punch grafts and punch excisions. I have positive personal experience with these procedures.
I'd recommend C02 lasers and/or dermarolling or stamping for the boxcar scars and slightly uneven texture.
You do have mild scarring. Don't feel too down about it, although I know this is easier said than done. 
Hi CherrySoda, thanks for the advice!
Do you think that punch grafts and punch excisions are something that can be done by dermatologists? Would you recommend this for the larger ice pick scars only? I have not seen these techniques offered by dermatologists on their website treatment lists. However, I will definitely be purchasing a Derma Roller. It makes a lot of sense. I will also look into laser treatments when I return home. As for my scars yeah they suck, but in a strange way, without spots and even though I have mild scarring I feel much healthier and better about myself than I ever did before. I'd be delighted with just a 30% reduction in my scars. How to achieve that is the goal!
Hi CherrySoda, thanks for the advice!
Do you think that punch grafts and punch excisions are something that can be done by dermatologists? Would you recommend this for the larger ice pick scars only? I have not seen these techniques offered by dermatologists on their website treatment lists. However, I will definitely be purchasing a Derma Roller. It makes a lot of sense. I will also look into laser treatments when I return home. As for my scars yeah they suck, but in a strange way, without spots and even though I have mild scarring I feel much healthier and better about myself than I ever did before. I'd be delighted with just a 30% reduction in my scars. How to achieve that is the goal!
I know that punch grafts and punch excisions are something that can be done by dermatologists. A cosmetic dermatologist performed those procedures on me.
I recommend these procedures for large and small ice picks.
You are welcome to read my acne scarring threat documenting my experiencing with repairing my ice pick scarring, among other things; http://www.acne.org/messageboard/topic/317164-in-need-of-wisdom-and-advice-for-my-scarring-with-pics/
Hope that helps. 
Hi CherrySoda, thanks for the advice!
Do you think that punch grafts and punch excisions are something that can be done by dermatologists? Would you recommend this for the larger ice pick scars only? I have not seen these techniques offered by dermatologists on their website treatment lists. However, I will definitely be purchasing a Derma Roller. It makes a lot of sense. I will also look into laser treatments when I return home. As for my scars yeah they suck, but in a strange way, without spots and even though I have mild scarring I feel much healthier and better about myself than I ever did before. I'd be delighted with just a 30% reduction in my scars. How to achieve that is the goal!
I know that punch grafts and punch excisions are something that can be done by dermatologists. A cosmetic dermatologist performed those procedures on me.
I recommend these procedures for large and small ice picks.
You are welcome to read my acne scarring threat documenting my experiencing with repairing my ice pick scarring, among other things; http://www.acne.org/messageboard/topic/317164-in-need-of-wisdom-and-advice-for-my-scarring-with-pics/
Hope that helps.
Cheers, I will have a look into these procedures. Interesting thread by the way, I see that you have only just finished taking Accutane and it has worked very well for you! Redness will improve significantly with time. Your scars also seem localised and shallow and therefore easy to treat. The best of luck!
Hi CherrySoda, thanks for the advice!
Do you think that punch grafts and punch excisions are something that can be done by dermatologists? Would you recommend this for the larger ice pick scars only? I have not seen these techniques offered by dermatologists on their website treatment lists. However, I will definitely be purchasing a Derma Roller. It makes a lot of sense. I will also look into laser treatments when I return home. As for my scars yeah they suck, but in a strange way, without spots and even though I have mild scarring I feel much healthier and better about myself than I ever did before. I'd be delighted with just a 30% reduction in my scars. How to achieve that is the goal!
I know that punch grafts and punch excisions are something that can be done by dermatologists. A cosmetic dermatologist performed those procedures on me.
I recommend these procedures for large and small ice picks.
You are welcome to read my acne scarring threat documenting my experiencing with repairing my ice pick scarring, among other things; http://www.acne.org/messageboard/topic/317164-in-need-of-wisdom-and-advice-for-my-scarring-with-pics/
Hope that helps.
Cheers, I will have a look into these procedures. Interesting thread by the way, I see that you have only just finished taking Accutane and it has worked very well for you! Redness will improve significantly with time. Your scars also seem localised and shallow and therefore easy to treat. The best of luck!
Thanks much. Best of luck to you, as well! I certainly will continue to follow your thread.
I have similar scars to you. They're essentially not deep at all. Shallow like yours. I've gotten fillers done twice, which the doctor said were going to be permanent if I continued a few more filler sessions after that, but I decided not to believe that b.s. and need to move on to something else. I wish all the best luck to you. Keep us posted!
I have similar scars to you. They're essentially not deep at all. Shallow like yours. I've gotten fillers done twice, which the doctor said were going to be permanent if I continued a few more filler sessions after that, but I decided not to believe that b.s. and need to move on to something else. I wish all the best luck to you. Keep us posted!
Thanks for the info, and the best to you too!
Dr. Roller dermarollers are high quality and expensive rollers. I used them for one year. Now I use only dermastamps. Dermastamps are less painful, less risky and they are better for targeting specific scars. Most people use 1.5mm, including me. On my forehead I use 1.0mm.
Dr. Roller dermarollers are high quality and expensive rollers. I used them for one year. Now I use only dermastamps. Dermastamps are less painful, less risky and they are better for targeting specific scars. Most people use 1.5mm, including me. On my forehead I use 1.0mm.
Hi Marco, thanks for the advice! Before I read your comment I literally just purchased a 1.5mm roller for my cheeks and a 1.0mm dermastamp for my temples and forehead. How spooky! So how often do you 'stamp'? Are there any tips or rolling/stamping patterns that I should be aware of? Have you seen any positive results so far?
Cheers
Dr. Roller dermarollers are high quality and expensive rollers. I used them for one year. Now I use only dermastamps. Dermastamps are less painful, less risky and they are better for targeting specific scars. Most people use 1.5mm, including me. On my forehead I use 1.0mm.
Hi Marco, thanks for the advice! Just before I read your comment I indeed purchased a 1.5mm roller for my cheeks and a 1.0mm dermastamp for my temples and forehead. How spooky! So how often do you 'stamp'? Are there any tips or rolling/stamping patterns that I should be aware of? Have you seen any positive results so far?
Cheers
I stamp once every 4-8 weeks. Sarah Vaughter has the best instructions for dermarolling/stamping available on the internet. That's more or less what I do.
http://dermaroller.owndoc.com/dermaroller-instructions.pdf
As for results, my shallow scars look better, but the improvements are so slow. I can't estimate a percentage yet. I saw the first changes 7 months after I started, but I didn't use any topical product back then. Now I use Copper peptides and a vitamin A cream and I'm reaching the conclusion that topicals are as important as the dermaneedling itself.