Doctor's Answers (4)
Sunken acne scars are also known as atrophic acne scars. These are shown to benefit from two main types of procedures:
1. Skin resurfacing (microneedling, fractional radiofrequency, various fractional lasers)
2. Subcision with or without fillers and biostimulators
I would suggest a proper assessment by an experienced doctor who is familiar with all these options, especially if you have never been offered them before. Sometimes, a single session of subcision can help more than multiple sessions of skin resurfacing, and hence be much more cost-saving. There are also various fractional lasers that have different effects for different scar types.
I agree with Dr Justin that fractional radiofrequency can definitely help more than microneedling (even with good stem cell serums), and I own a fractional radiofrequency device at my clinic too. However, this device may not be suitable for all scars. It is useful for rolling scars, and other devices are still required for different scar types. Fractional microneedling also break the top layer of the skin and can cause increased downtime if used to deep depths, higher risk of infection/acne and also increased sensitivity initially (just like lasers).
If you have deep rolling or box scars, fractional non-ablative lasers like the erbium-glass laser are a proven better option than fractional radiofrequency according to this study (Comparative study on efficacy and safety of 1550 nm Er:Glass fractional laser and fractional radiofrequency microneedle device for facial atrophic acne scar.) A proper assessment is still crucial before any treatment.
It is a misconception that lasers make the skin thinner and more sensitive. If done appropriately and with proper rest intervals, lasers increase the thickness of the skin and can even decrease skin sensitivity. Similar to fractional radiofrequency and microneedling, the skin can be more sensitive during the initial healing phase, so proper post-care is also important.
Microneedling can be an alternative treatment since you are increasingly getting more sensitive to fractional CO2 laser. However, it must be known that you may need many more treatments and it may not be as effective for deeper scars. In my personal opinion, I do not think the cost will be a lot lower given the more sessions you may need but if sensitive skin is a major concern, then yes, it can be an alternative treatment.
Although fractional CO2 laser does not thin the skin, it certainly can make your skin more sensitive in some cases. The way to overcome that is not to do the fractional CO2 laser too closely and give enough rest time in between. The other important thing to note is the aftercare after fractional CO2 laser is of paramount importance in avoiding or reducing the chance of sensitivity. The power and level of fractional CO2 laser are also very important and depends on the expertise of the doctor in knowing how sensitive your skin is and what you will be able to handle for optimal results and yet with good safety margin.
From the thousands of fractional CO2 lasers done, I have only seen a small handful of patients getting sensitive and proper counselling, intervals of treatment and power used are very important.
Other alternatives to scar treatment include subcisions (for the brave ones) and dermal fillers. I do not think there is a place in fractional radiofrequency as the results are poor and I have seen the trend died almost as quickly as it appeared. Buying some of these machines is a waste of money and I think if we have a useless machine, we should just write it off instead of passing the cost to patients. As such if you think of the price, it's certainly not even cost-effective as well.
Micro-needling gives good results for superficial acne scars over multiple sessions. However, it is unlikely to give good results for deep acne scars.
For deep/severe acne scars, you would still need Fractional micro-needling Radiofrequency, like Infini, which can deliver RF energy to depths that Fractional CO2 cannot reach. Devices like Infini can deliver RF energy up to depths of 3.5mm, whereas Fractional CO2 delivers energy up to 1mm deep.
Please consult a doctor for a more detailed discussion. Hope that this helps!
Dr Justin Boey
Microneedling has been used for a long time but it is probably not enough to treat moderate to severe sunken acne scars.
The best acne scar treatment really depends on the type of scars you have
If your scars are predominantly ice pick and tethered rolling scars, you can expect improvement with just a few sessions of TCA cross and scar subcision. This will usually be cheaper than a few sessions of fractional laser/ microneedling RF. Consult a doctor to get an accurate assessment first before proceeding.
Hope this helps!
Dr Jiwei Wu