Hi, I have had horrible acne since freshman year of highschool. Now i'm in my 30's and only get the occasional pimple but it goes away fairly quickly without leaving a scar. My PIE and Scarring, on the other hand, has been the same for 10+ years. The redness has faded VERY SLOWLY over the years but doesn't seem to be fading any more. What are my options?
Sorry for the blacked out marker. I'm embarrassed 
Hi there you mainly have box cars and a few icepicks.
I do think your major issue is Hyperpigmentation aka PIE (redness), picosure laser is great for this or v-beam.
Regarding you seb Hyperplasia, look for electrosuergery aka hyfecator 5W or laser treatment to release the plug.
The scar plan will take work.
You have severe scarring, tethered box cars mainly and a few icepicks.
Subcision is necessary 4 sessions. I would do cannular subcision if you can as you have scars on your temples and this is safer. Filler can be used as you have fat loss. Typically in situations like this I say use dilute Sculptra, throughout the face - why... because you have widespread scarring. HA filler can be used later on the individual pits. OR just do filler on your last subcision.
I would do Low density and high power co2 3-7% with the highest power multi-pass and have them smooth out the border of the box cars (Walls only not inside of the shap scars) or RF microneedling. You need a few sessions of this.
TCA Cross is needed on some scars, and A few of your spots can have paint on or spot peels with acid inside the boxcar. See what this means in the FAQ, top of the acne scar sub, first post, goto the acid section, mega post link, and paint on area.
Treat nightly with tretinorin and a hydroquinone or konjac and arbutin cream to avoid further pigmentation issues.
I would then do a series of lightening peels TCA or Glycolic for the texture or Erbium Fully ablative resurfacing.
Everything is optional, treat as you have time and money. 3 months between treatments. You can even do one thing a year. Some subcision and tca cross work/ spot peels will help a lot if you do nothing else.
Dermaroller or Dermastamp at home between treatments for further improvement and do a series of glycolic or other acid peels.
Hi Beautifulambition,
I did about 4-5 treatments of V-Beam would helped the redness. It's still pretty red though. My derm also tested electrosuergery on some of the sabaceous hyperplasmia but I noticed the bumps came back after about 2-3 weeks. She tested about 10 different bumps big and small. Is this normal?
Edit: Also how do I find a GOOD derm in my area? My current derm has good reviews but she is always rushing with her patients so I don't feel like she really cares about each individual.
@abstractworldFind someone who can treat with laser if Electrosurgery does not work. Aesetics Dr not a general derm.
There is a list in the FAQ- top of the acne scar sub, first post, bottom. Many travel for the top 1% of drs, but there are other drs and plastics and med spa's nearby.
Sounds like the v-beam settings are not right, possible, or you need something stronger/deeper like q-witch laser.
Treat as you have time and money, everything is optional, some treat over 3 years, 3 months between treatments is optimal as we heal slowly, subcision is most effective for many with pits.
Thank you for the kind understanding and patience, due to Dr Lim's endorsement of this forum we have massive new traffic, it may take me 24-hrs to get back to you.
BA