Hello everyone. I began to break out in cystic acne around age 25 after going off birth control (turned out I have PCOS). I saw an endocrinologist a month or two after the breakout began and she said she could prescribe Spironolactone but seemed hesitant to prescribe it, cautioned heavily against potential side effects and made it clear I would have to stay on the medication permanently. I had suffered from smaller breakouts in the past when switching on and off birth control so I decided to wait and see if the acne would go away on its own after my hormones adjusted and treated it with over the counter products in the meantime. Unfortunately after six months the acne would not clear up on its own, so I had to start the medication anyway and I was left with pretty extensive scarring.
I initially used tretinoin for a few months while the lesions were clearing up, then swapped to TCA peels every four to six weeks. (I would have to discontinue the tret for a week before and after each peel so I just stopped using it.) These were light to medium peels, no frosting. I was suffering from PIE so I followed with four pulsed dye laser treatments which unfortunately were not effective (the redness took about two years to fade on its own). I saw a second dermatologist who recommended Fraxel for my scars but I saw no results at all after the first session so I did some research on here and decided to pursue manual methods.
I found my current dermatologist online and he recommended RF microneedling with PRP. I asked about subcision but he felt my scars and said I did not need it. After three sessions I have seen good improvement, but I have been considering going to Florida (I live in Atlanta) to see Dr. Weiner for fillers and TCA cross, possibly a phenol peel for any textural scarring. At this point I am 28 and have been treating the scarring for about two years. What would your recommendations be with my current levels of scarring? I™ve attached two sets of pictures - one in harsh overhead lighting and one in natural light. Thanks!
Your skin is looking great. It's usually best to do as little as you can to achieve results. Phenol peels are pretty hardcore, so ask your specialist if that's worth the risks.
It looks like you've done a great job so far. Keep us posted on what you do and your results please. And proceed with caution. You are looking so good it would be terrible to see complications from a procedure that is too invasive at this point.
Also remember that scars tend to fade with time a bit. Perhaps it's time to be happy with your skin? Just a thought.
Phenol peel won't erase boxcar or ice pick type scars. You can consider it later when all your scars are level with the rest of your face, but your skin looks too good to go through something like that. You should try CROSS (phenol or TCA) multiple sessions. I've never done RF needling because I'm not a fan of that type of treatment.