Q: Dr. Eppley, I am interested in surgical scar revision for my box car acne scar. I have undergone microdermabrasion, fractional laser resurfacing, and TCA peel to the area but none of them have had any beneficial effect. It seems like something deeper will need to be done or perhaps just cutting it out. I don’t know as I am not a doctor but none of these other doctors seems to know either.
A: As you have discovered, none of these superficial treatments are going to work for your type of facial acne scar. This is a problem of tissue atrophy/loss not one of just a more simple surface contour irregularity. Your acne scar surgery options include either excision and geometric scar rearrangement or scar adhesion release and injectable fat grafting. You can first test out how well fat grafting may work by having some injectable filler or even a trial of saline injections done to see if the scarred area will lift up by adding volume by injection underneath it.
Give its size, total excision and a geometric closure is also a consideration. What needs to consider how much tolerance one has for the healing and maturity of a scar on one’s face vs. whether one wants to first try an injection approach before embarking on a ‘bolder’ excisional approach.
Dr. Barry Eppley
Q: I am a 40 year old male with medium acne scars over my cheeks While I have acne scars other places, these are the most bothersome to me. Will cheek implants help lessen the acne scars and be a good anti-aging step?
A: Acne scars come in a variety of shapes which determines what procedures may be helpful for them. Surgery by excision is the preferred approach, for example, of the classic ‘ice-pick’ acne scar because of its depth. No superficial treatment of a deep acne scar, such as laser resurfacing, will work.
Many of the most troubling acne scars over the cheek area tend to be the ‘saucer-shaped’ variety. These are larger, less deep, acne scars that do resemble a saucer or a moon crater. They still are too deep to respond well to laser resurfacing (taking down the edges will not usually work) and their larger surface area causes a noticeable contour deformity. These are the type of acne scars that can respond well to injectable fillers as the problem is loss of skin dermis (thickness) and some subcutaneous fat. They represent a true volume deficient problem.
While injectable fillers can work for cheek acne scars, it is not unreasonable to consider the push of an underlying cheek implant. By pushing out from the bone, the expanded underlying tissues can help ‘fill out’ some of the saucer-shaped skin depression. I have done this a few times and do find it helpful. The existing size of the cheek area should be considered as the trade-off of a flatter acne scar for an overbuilt cheek may not be worth that trade-off.
Dr. Barry Eppley