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Acne scars. Doctor suggested 2 CO2 lasers but idk if I should go for lasers before trying others

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Hi, I have been reading some posts here and found the comments by the community helpful for a second opinion. Therefore, I'd like to post my own photos and would greatly appreciate any suggestions too! 

Background: mid 20s, oily skin, using epiduo every night, never taken isotretinoin, never received any scar revision treatment yet, acne still pops up once in awhile

I consulted an aesthetic doctor and the doctor suggested 2 session of CO2 lasers (I did not ask if it was a fractional or an ablative), no subcision and no tca needed

But after reading some of the posts here, it seems that lasers should only be used as a last resort

In this case, I was thinking that RF microneedling (not entirely sure an insulated or non-insulated yet) may be a better choice as compared to CO2?

I would consider laser too if it gives a better result overall but was worried about the post-op orange peel skin or worse scars from laser

I believe my scars are mainly box scars, enlarged pores, and ice picks..

please let me know your opinion :)






EDIT: Should I stop using epiduo and move to differin and consume low dose isotretinoin to combat active acnes? I feel like I'm tied to epiduo, if I miss a day or two a new acne pops up. This makes me consider taking low dose isotretinoin to clear up acnes

Edited by asianskin100

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OP, your scars honestly look very minor and there's a good chance it's not worth any treatment at all since they come with the risk of making things worse. IMO, you should consider Vbeam to reduce the redness and then see if that alone was enough to make you happy with your look and then at that point consider getting any other work done on your face.

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You have very minor scars. Doing laser treatments are not without risk, so why would you bother. I doubt anyone else would notice your scars, except yourself.

What is your goal? Glass smooth skin? That will never happen as scar treatments haven't advanced that far. I'd save the money and buy something nice for yourself.

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Hey @UptownOryx and @ScarRight, thanks for your input. Some of the scars are still kinda disturbing to me. But yes, thanks for pointing out that laser may not be necessary considering the risk does not worth it. Thanks @UptownOryx for suggesting Vbeam, I will def look into it. I uploaded some pics here with different lighting, could there be any treatment that would be suitable?


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You do not need lasers.


Your scars are very mild, and you should expect a very significant improvement, I would imagine 80+ percent.


You have icepick and boxcar scars. These respond very well to TCA Cross and RF Microneedling.


I would avoid lasers entirely, they are not needed for you scars.


I recommend:

  • TCA Cross (4-5 Sessions)
  • RF Microneedling (3-4 Sessions)
  • TCA Peel (if needed)


Your scars are so so mild OP. They can be fixed very easily.


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Ok where to start we have the OP's post and the responses.

@asianskin100 Yes most Dr's who are clueless about acne scars suggest fractional co2 laser. Which will not fix your issue alone. Then you will come back to me and said it did nothing. We always start with manual methods first. 

You have textural box cars, look at the temples for example and the circles on your cheeks. As such I would do cannula subcision. I would not use filler here two superficial, ... you can use prp or Chinese cupping (Amazon).

Yes you also have PIE redness or wounding post acne, but I also see PIH or Hyperpigmentation . As such I would not use v-beam on you as it' will not be effective for your issue. I would use picosure on your for your discoloration and to stimulate collagen. It works great on your skin type. If they don't have that get Q-switch done.

Some of your boxcars you could do paint on TCA, basically it's 3 coats in one session to the floor of the scar. See the acid peel guide for more info on it, ... At the top of the scar treatments sub. You do several sessions of this.

Then you could do rf needling for the box cars, or fractional erbium. CO2 is they are just stamping does not work so well for your scar type. 

Oh yes always insulated needle rf needling, that is what makes it superior to laser right, it avoids your upper skin epidermis. 

Your already using Epiduo was it so you don't need to use Use retin-a/tretinorin/differin every night as you already are. But I would add a cream that has ingredients kojic acid and licorice. Your skin hyerpigments easily this prevents it.

IF you want to just try things at home first buy a dermastamp and stamp your box cars, ... temples etc... I don't think alone this would do much, but in between treatments it's worth doing. You treat with the Dr every 3 months, ... the body is exceptionally slow to heal. Everything is optional. 

Your large pores could be caused by epiduo, ... if the moisture barrier is destroyed thought acids then we get pore issues. Might be worth Googling restoring moisture barrier. 

Ok with all this info and confusion where to start. Well you could do picosure and get rid of the redness - discoloration and you may be happy with just that. Or you could do the tca cross / pain on and subcision, ... be aware that the areas treated will be red for a few months, then you would do picosure after, wear some concealer if needed. There is another poster on page 1 of the scar treatments sub who is Korean with similar skin issues as your check out his post. Gimozzi, or something forget name. 

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@beautifulambition, thank you for long and detailed explanation, and thanks for the recommended treatment. 

I have never heard of Picosure but after doing some survey online, I think it's worth a try! 

As for PRP, it is in conjunction with microneedling? Some online resources seem to recommend this way, but I believe what you meant was PRP injection only right?

I'm kinda worried about subcision and TCA as they require good skills from the doctor and the risk is higher.. but I will keep them in mind in case I need further scar revision

 I goggled on "restoring moisture barrier", here's what I found, I'll just leave a note here in case anyone's reading, BA could help to confirm if these are accurate too:
1) avoid exfoliating the skin
2) Apply moisturiser with active hydrating ingredient such as:  Glycerin, Hyaluronic Acid (HA) or Urea. Personally, I'll try to find a product with Glycerin first.

I am also trying to reduce the use of Epiduo, although it works to reduce breakouts when applied all over my face, it also causes pores and makes my skin really dull and oily during the daytime (as compared to before using Epiduo, I've been using for more than a year).
>> This made me consider taking low dose isotretinoin for acne and oil control, 40mg/week, but after reading on some posts here, heavy initial breakout should be expected along with other side effects. However, I have also read some posts that mentioned for some people, IB did not happen for them when taking low dose isotretinoin. So I am not sure if I should:
A ) Cut epiduo (in the hope to reduce moisture barrier damage, dull and oily skin) and take low dose isotretinoin
B ) Switch to Differin (adapalene only, no benzoyl oxide) for everyday full face use and apply Epiduo only for spot treatment. This however, still does not solve the moisture barrier damage that acid brings? Idk..

Between these 2 options, would A better solves acne problem?

In terms of hyperpigmentation, I tried to look for product with "kojic acid and licorice" but hardly find anything except one that is on Walmart.com but I live in Asia so it would be quite difficult for me to get the product. Is there any product that you could recommend? or other active ingredients that would be helpful too as an alternative to "kojic acid and licorice".

Once again, thank you so much for volunteering and helping on this forum along with long term acne sufferers.

Edited by asianskin100

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@asianskin100 They are doing PRP these days in combo with rf needling, or laser. I would not bother with microneedling unless it's in a package. 

Yes those are good steps to repair the barrier.

Your skin chemistry is probably out of wack hence the oil issues and pores. 

Either option could work A or B, best to discuss this with a board certified derm who is prescribing these things . 

** Please Note I offer to acne scar suffers a "more" "customized" (private) consultation than the above general advice. Analysis, answering questions, ongoing support by Private Messaging. Feel free to message me there. Be patient as I can get over 100+ of the worst acne scar cases to help, it "may" take me up to 48 hours to respond.

Checkout the main scar treatments sub, find the FAQ pinned on top there, goto the bottom, there are Dr's or call around and ask who does cannula subcision or nokor subcision (needle type) to dermatologists and or plastic surgeons, consult a few before you decide who you like, even if you have to pay as treatment is expensive, better like them. Ask how many subcisions they do a month and if they treat your skin type. If they just do laser run they will just blast you and not solve your issue.

Disclaimer: Information and support is not meant to diagnosis, treatment, or cure any health or mental condition and is not a substitute for professional face to face medical care  (consult with a few Dr's and pick your favorite one). Posts are for informational purposes only, please consult your personal health care practitioner before engaging in anything discussed. 



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