Acne Scar Treatment - Combining of prp for improved skin texture, and filler for elevation

Thank you for your question. You’ve submitted several photos and you're asking whether PRP MicroPen versus PRP injection will help acne scars. Well, I can certainly assist you with this question. I’m a board certified Cosmetic Surgeon and fellowship-trained Oculofacial Plastic Surgeon practicing in Manhattan and Long Island for over 20 years. And PRP is a very important part of my practice. I’ve been using this for a long time and we use it in a lot of places including the treatments that we’ve developed for hair loss as well as the treatment of fine lines, wrinkles, under eye dark circles, and of course acne scars. I’m very encouraged to see more questions about PRP since there is a lot of skepticism about the benefits of PRP in spite of the incredible amount of data that already substantiates its use in the fields of oral surgery where it originated, as well as in orthopedic surgery. The questions that we have to answer as physicians offer – providing care for aesthetic needs is what PRP can and cannot do. And I think a lot of people have – don’t understand PRP especially doctors. And I have had – I’ve seen a lot of ignorance amongst physicians who claimed to be experts on everything in spite of their lack of experience in PRP; and their willingness to be negative about it. But since in my – from where a simple perspective of how education is for me in medicine since there’s no huge multi-billion dollar company as there are with lasers; promoting PRP, it really takes the experiences of individual patients to help other people learn more about it. So the good to answering your question, it’s not an either, or question. We have to understand really what is the cause of acne scars in terms of the permanence and understand what the strategy is. So I’ll explain to you what I do in my practice. When people like yourself come to us with a situation like where you’ve had, obviously cystic acne in the past and you’ve lost a lot of skin – of tissue and there’s scarring. So the question really is how do we help this area look better. A lot of people have tried using lasers very aggressively but I tend to avoid that especially in younger people because essentially for my experience, a laser could help. But if you're too aggressive, you're almost sacrificing good quality skin to try to make it even with scarred skin. And it doesn’t make sense to me to do it that way. What I do in my practice is first diagnose and differentiate the areas that are most obvious and draw the – both my attention and the patient’s attention. And we work out a plan to help those particular areas. Now for areas such as where there was called rolling scars and boxcar scars, what we tried to do is release first the scar under the acne scars to a technique called subsition. Then I would actually inject not just PRP, but I’d also inject a hyaluronic acid filler such as Restylane and Juvéderm to try to lift up the tissue and allow for release. You see, an acne scar is not just an indentation, but underneath the scar, there are bands of tissue that’s holding it down. So when you think about like micro-needling which helps improve texture on the – on the surface, it’s not going to release what’s going on underneath. So for deeper irregularities, we basically in two categories; where we go in deep scars versus superficial fine irregularities. Deep scars do well with subsition and some type of volumization. So for me, that synergy of a hyaluronic acid filler with PRP is a fantastic combination. And then for more superficial quality of skin, more evenness, microneedling with PRP is great. Now it is also important to understand that acne scars are not treated as a single procedure. A typical story of a patient who has acne scars is a bounce from one doctor to another. They bounce from one technology to another. They go to one place, they try something, they’re disappointed, they go somewhere else; they try something, they’re disappointed. It’s all about communication. What I tried to do is explain to these patients that there is no perfect solution and there won’t be a time where the skin will be flawless. But there is its strategy to try to improve the overall appearance. And what we – and what we’re doing is as almost like muscle building. We’re doing something and then we’re building on what was done before. So I think that understanding that, it’ll may give you a better perspective on how to make your decision. But when I see a patient who has acne scars, I was – I would say to someone like yourself is, there’s going to be a long term plan. And we treat, we observe, and then we come up with another plan based on that. And there is – there are – there are many ways to do this but it’s very important to always have a perspective and of course, you know, appropriate amount of time and budget to be able to do these things. So I hope that was helpful. I wish you the best of luck. Thank you for your question.