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Strange_Tangerine

Help with treatment for forehead acne scarring?

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Hi, everyone!

I have suffered with bad cystic acne for about 3 years. I have finally gotten to a place where I no longer break out. Long story short it took me 3 years to realize I had food intolerances that would break me out in. Unfortunately, I now have some forehead acne scars. So here I am!

I have had these scars since around 2016 when I had my worst acne breakout. Since then I have made sure to wear sunscreen daily, and have been using Tazorac for the past six months. However, I do not personally feel the Tazorac is helping very much. This is my second round of trying Tazorac (first was to combat acne when I was still breaking out), and I feel that now that I know how to control my acne, I would rather try some more invasive methods (microneedling, lasers). In addition, I live in a very warm and sunny climate, and with Summer coming up, I do not want to worry about the extra skin damage Tazorac could bring, as I will be at the beach often.

From what little I have learned about acne scars so far, I have predominantly boxcar scars. I believe that the largest two scars right in the middle of my forehead are rolling (?) scars from cysts, and are deeper than the others. Some of the marks on my forehead are PIH, which I am not so worried about. I have attached close up pictures of my skin underneath an overhead light aka the most unflattering lighting.

I am very new to the sub as well as the SKA community, and I really want to learn as much as possible about scar treatments before I go and get anything done.

Now, I have questions for anyone who may be able to answer:

~My dermatologist recommended "Laser Genesis," and they also offer microneedling. These were the two treatments I was leaning towards, and my dermatologist said we can do the two in conjunction with one another, i.e. laser, wait two weeks, microneedling, for three sessions each. Would you all recommend this for these kind of scars? Anything different I should look into instead?

~The person who does the microneedling is an esthetician. Is this routine, or is it usually the dermatologist doing the microneedling? I was apprehensive about someone without medical credentials.

~Can microneedling/Laser Genesis make scars worse? I am planning on getting the needling done in office; I don't trust myself to do it at home.

~Will they go away/get better on their own?

~Any advice about scars/scar treatments/your experience is truly welcome. My scars don't look as bad in person, however I do still get very self conscious about them, especially under bad lighting, like in stores. However, although they bother me I don't want to jump right into a treatment that might worsen them. I need all the advice I can get!

Current Routine

AM: Wash face with Aveda Botanical Kinetics Purifying Gel Cleanser, then apply Ambi Skincare fade cream. Moisturize with Aveda Botanical Kinetics hydrating lotion. Apply Skinceuticals Physical Fusion UV Defense SPF 50.

PM: Remove makeup with Costco makeup wipes, wash face with Aveda Botanical Kinetics Purifying Gel Cleanser. Moisturize with Aveda Botanical Kinetics hydrating lotion.A few times a week I apply raw honey to my face as a mask, or use a salicylic acid spot treatment if needed.

IMG_2038.thumb.jpg.ba2a7a7ac78fb8a701e3fc1427c0e1f3.jpgIMG_2039.jpg.757428cbe915f02bf8d266e4a4e45943.jpgIMG_2040.thumb.jpg.220509027df8d664f6a744d6549317c3.jpgIMG_2043.thumb.jpg.adb1675ccb76dffb4fd83504508e4648.jpg

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Derm should do manual vertical subcision with neurotoxin 8- 10 units, then saline vertical subcision - end point is the ' crunch of scars' with vertical delivery.  IMO  these are very difficult scars, and your dermatologist should take responsibly to treat them, not delegate. If they are experienced, finish treatments with non Vycoss HA fillers, very superficial , Beville up technique. Challenging and difficult scars to treat, but if you have the correct dermatologist, significant gains can me made. In this area you only have 1.5 mm to work with, from skin to bone, so accuracy is essential- wish you well. Few scars will benefit from TCA 80-90% CROSS. 

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17 minutes ago, Obi wan said:

Derm should do manual vertical subcision with neurotoxin 8- 10 units, then saline vertical subcision - end point is the ' crunch of scars' with vertical delivery.  IMO  these are very difficult scars, and your dermatologist should take responsibly to treat them, not delegate. If they are experienced, finish treatments with non Vycoss HA fillers, very superficial , Beville up technique. Challenging and difficult scars to treat, but if you have the correct dermatologist, significant gains can me made. In this area you only have 1.5 mm to work with, from skin to bone, so accuracy is essential- wish you well. Few scars will benefit from TCA 80-90% CROSS. 


Hey! Thanks for the reply! Should I try to go to a plastic surgeon for this? I live in Hawaii and am not sure if there are any dermatologists specializing in acne scars like there are on the mainland/East/West coasts. Do you think using a Tazorac cream will do anything for these scars, or is it better to just go with procedures? Thanks again :)
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@Wdotgrimes Yes this advice works for your scar type as well.

@Strange_Tangerine I don't think most plastic surgeons can or will do this. This is specialized scar work, perhaps Dr Rullan. But maybe you can find someone nearby. Again this is a very hard area to treat, with anatomy that is dangerous underneath.

Tazorac alone will not fix your scars but please continue it with konjac and albutin cream nightly to help with any discoloration and to do quicker cell turnover. You can try to dermastamp them for "some" at home work. Stop 1 week before procedures.

What Obiwan is talking about is manual scar work to the scars. Vertical subcision and some botox. Saline vertical subcision. HA filler superfically in this very dangerous area to inject. Low density co2 3-7% is also a tool used. Dr Rullan might use acid to spot peel certain scars. 
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