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What kind of scars are these? What should I do to reduce them

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I am left with these horrible scars after adult acne. I have had chemical peels, dermaroller, laser treatments with barely any results. Should I be looking into subcision? Please help me understand these scars better and find the best treatment for them. 6B9C4B3D-B070-4A05-B3AD-145696D1812C.thumb.jpeg.2aaaa80a9bf5557b8d704a3b3c19206b.jpeg381A4914-26D9-45F0-8A80-E0FF53DEF171.thumb.jpeg.591ea8757f99aa7c943694ab3b5669aa.jpegB32F586F-7638-46C7-848F-0698DC7409C8.thumb.jpeg.5da09a8b566cad70ecd7100263987953.jpeg381A4914-26D9-45F0-8A80-E0FF53DEF171.thumb.jpeg.591ea8757f99aa7c943694ab3b5669aa.jpeg694489EC-E831-4658-9C35-437869A35999.thumb.jpeg.f25d8acba5ffbb65b513a779e5f3cc8c.jpeg1A77C309-896A-4D7B-B86A-145AA0347B6E.thumb.jpeg.53998d3552dcbff04b19d92c94e4b3ab.jpeg

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Thank you for your patience. Due to Dr Lim's Endorsement of this forum we have higher traffic than normal. Response will be 24-hrs. 

Yes you do have severe scars.

I see a problem with treatments that are not targeted to your scars. Many just throw laser at it and that is not how a top acne scar Dr - 1% would treat. 

Ok so I see fat loss, A Linear Scar that is deep and wide. Textural issues. Rolling and box cars.

Yes ... you do need subcision! Possibly 4 or more sessions. Filler will be needed. Space them out when you need a top up from filler again. You need Volume, so several mls of HA or a vial or 2 of Sculptra and then your last subicsion individually fill the puts with HA filler. 

Between your subcisions...You will need paint on also called spot peels (3 layers to only the floor) of each box car and that long linear scar. This will take several sessions.

I would do angled co2 to the box cars, and that linear scar... 3-7% density at the highest power, and fractional traditional laser to the beds of the scars. We need to soften the transition on the box cars. Many providers do not know to angle the laser for this. You may also need rf microneedling in conjunction (optional), depending on what is available.

As you have severe scars you will need a deep peel by a plastic surgeon, .. not light acid peels, ... or fully ablative erbium resurfacing for the texture issues once we raise and smooth the scars.

Treat as you have time and money, scar work is never quick it's a marathon, ... allow 3 months minimum between treatments, many treat over 3 years. Everything is optional. I would see Dr Lim, Dr Rullan, or Dr Taylor as you need more agressive treatment.

Use retin-a/differin/ or tretinorin nightly. 

I Want you to buy a dermastamp or derminator and stamp only the scars between Dr performed treatments. 

I see red PIE, ... V-beam or picosure is the appropriate laser to deal with vascular issues. 

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Thank you for responding! I’m not quite sure where to begin. Should I get the subcision first or start with some TCA cross peels. Are there any special instructions or the subcision e.g. needle type, length etc. Another factor would be that I will start trying to get pregnant in two months( had a Myomectomy in May, so Dr. Advised me to wait for 6 months before trying) I have heard that peels and laser are out of the question when pregnant. Please suggest what I should do in this two month window I have. It’s been a week since I have started using a tretinion .05 at night. I alternate with some AHA and BHA serum. The pimples have reduced since the last few years but my skin tends to get closed comedones where I have scars and on my chin. I wish I could get Dr Lim’s help but unfortunately I live in a different continent. 

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@Pearl1983, BA has given good advice, but I just wanted to jump in here and say that you should FIRST get your active acne under control.  I see you are still breaking out, and trying to "fix" scars without first addressing the inflammation from current acne is a fool's errand.

Please take a look at your diet, and lifestyle - for me personally, cutting down oils, increasing vegetables (cruciferous and leafy greens in particular), maintaining a frequent exercise regimen (sweating), and reducing smoking/alcohol all helped in curbing my acne.  You can also look into topicals and prescriptions if you address all the lifestyle changes, and it doesn't completely resolve the acne.

Once acne has gone down, subcision and microneedling / peels will help. DO NOT stamp or needle active acne, that will make things worse.  Good luck!

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@Pearl1983 Yes you can do subcision if trying to get pregnant, but it's up to the Dr's discretion. No there are no special instructions with subcision. Cannula or Nokor, .. .depends what the Dr uses by you. 

If the Dr says peels are out of the question, then TCA Cross is out of the question as it uses acid at their discretion.

grandor is right, please get the acne under control or you can spread things and make it worse. 

Tretinorin is vitamin A, ... should you be using this wile trying to get pregnant, ... please consult the DR, Vitamin A can be harmful to this regard. 

I would have  hydropeels or extraction of of all your pimples / closed comedones. For early scarring e-matrix is useful but in your case as your trying to get pregnant it is up to the Dr's discretion. 

You may have to wait for the majority of treatment until you have your baby. 


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