From the picture given, your uneven skin tone and texture is due to a combination of acne scars (mainly atrophic and rolling scars, with a few ice-pick scars) and post-inflammatory hyperpigmentation (PIH) from acne that you had previously. Options for treatment in your case will include:
1. Radiofrequency Microneedling (INFINI) treatment – this “volumizing” treatment will improve the scars greatly by stimulating collagen synthesis via the different depths of the insulated microneedles.
2. PicoSure Laser treatment – Harnessing the picosecond laser technology and its patented focus lens technology, acne scars can be treated with better results and shorter downtime compared to traditional fractional laser resurfacing. At the same time, the PicoSure laser toning can treat the PIH as well.
3. Fractional CO2 laser – this works by ablating scars away and creating microthermal zones that are surrounded by healthy tissue, allowing for healing and collagen production to even out skin texture and scars.
4. Polynucleotide injections e.g. Rejuran – Through various biological and cellular mechanisms, polynucleotides enhance DNA repair, accelerate tissue repair, reduce inflammation and improve skin texture by increasing collagen synthesis. This results in improvement of acne, scars and hyperpigmentation.
5. Subcision – This procedure using a special form of needle called the Nocor needle is particularly useful for depressed and rolling scars where there is a lot of a fibrous tethering in the underlying skin. By freeing up the fibrous tissue beneath, the depressed and rolling scars usually become shallower and allow for other treatments like lasers to work better subsequently.
6. Dermal fillers – This is particularly useful for isolated atrophic small scars to restore volume to the depressed scar area, and is sometimes done in combination with subcision to give better results.
7. Trichloroacetic Acid(TCA) CROSS – This treatment uses tiny amounts of trichloroacetic acid to improve scars, hence the synonym CROSS - chemically reconstruction of skin scars. This is particularly useful for small ice-pick and atrophic scars.
In my practice, no one patient is the same and each individual needs to be assessed properly and a detailed customised plan of treatment is done. In most cases, a combination of the above treatment gives the best results.
In your case, from the picture given, I would recommend a combination of PicoSure Laser Toning to improve the shallow scars and PIH followed by subcision and radiofrequency microneedling to improve the deeper scars.
