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What kind of treatment do you recommend ?

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Hi there,

You have mainly rolling and box cars with fat deficiency in the cheeks.

I would start with subcision and do filler (you will need 4 sessions of this spread around your rf microneedling). Filler is essential in your case, and does require a top up, if you like it down the road you can get something like PMMA or Bellafill but I would not start here as it's not reversible and the body needs to heal during revision (HA is naturally found in the body).

I would also do RF Microneedling, there are many brands including infini, secret, intracel, intensif, etc... (you will need 3 treatments of this).

I would then do either several TCA peels (derm, or med spa) or a Sedated TCA peel with a dermatologist or plastic surgeon to get under the scars and resurface the skin. You may need more than one , ... another option is erbium ablative resurfacing with a laser, but I would start with peels - less side effects. Goto a doctor who specializes in your skin type for resurfacing. 

Please checkout the FAQ - top of the scar solutions sub, first post, and look at subcision, and tca peels. You can have some good improvement, but it will take take. For some that is over 3 years as they have the down time and funds. Also The body needs time to heal so please put some months in between treatment's to rest.

Edited by beautifulambition
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+1, totally agree with BA's plan. Subcsion with Nokor however I would consider blunt dissection with cannular subcsion as well. Why? Because of the extent of scarring. Nokor is more accurate, and provides finesse to specific scars, blunt dissection with HA will improve your cheeks, with less chances of haematoma- seroma. The key is to work UNDER your skin - namely break up bond holding your scars down, then replace loss volume (atrophic scars) with fillers. As suggested by BA, follow up with RF microneedling - this allows more scar remodelling directed vertically as well as to stimulate your immune system to lay down more collagen- elastin. You will need multiple treatments, but these scars can be dramatically improved with the correct combination. Laser is not the first line solution. 

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A clear case for revolumizing with filler or fat.  You can make a case for Sculptra here because you need quite a bit of volume. Although it is not instantly reversible, but will take years to degrade naturally.  Subcision and HA filler (brands like Voluma, Restylane Lyft) is a good way to gauge if you actually like the effect.  If you like your how face looks with more volume, than you can do something more long lasting like Sculptra or fat.  There is of course permanent fillers, but I would be careful with those because you would need quite a bit of it.   Injecting permanent fillers at those kinds of volumes does pose a greater risk.

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