Hi, everyone. I’m Dr. Qazi, a skin restoration specialist based in Newport Beach, California. My practice focuses on helping patients with acne scars, pigmentation issues, and collagen stimulation. Over the years, I’ve developed techniques that deliver natural-looking results while prioritizing patient safety and long-term skin health. Today, I want to share my approach to treating complex cases like the one you’ll see below, where subcision, bio-stimulatory fillers, and TCA cross treatments were used to achieve remarkable improvements.
A Complex Case: Transforming Scarring Without Lasers
One of my favorite cases is a patient who came in with severe scarring that had aged him significantly. His Fitzpatrick 6 skin type and the nature of his scars—boxcar and rolling scars—required a personalized treatment plan. We avoided lasers because of his busy lifestyle, work commitments, and the risk of post-inflammatory hyperpigmentation (PIH). Instead, we focused on manual subcision , volume replacement , and TCA cross treatments.
Here’s how it worked:
- Subcision : I used blunt cannulas, Taylor liberators, and Nokor needles to break up scar tissue underneath the skin. This releases tethered scars and allows them to rise to the surface.
- Volume Replacement : For this patient, I used bio-stimulatory fillers like Sculptra and Bellafill . These products stimulate your body’s natural collagen production over time, creating lasting improvements in skin texture and volume.
- TCA Cross : This chemical treatment targets individual scars by breaking them down and encouraging new skin growth.
Within six months, the transformation was incredible. His scars became less noticeable, and his overall skin quality improved dramatically. The best part? He experienced minimal downtime compared to traditional laser treatments.
Why Bio-Stimulatory Fillers Are My Go-To Solution
When it comes to restoring lost volume and improving skin quality, I believe strongly in the power of bio-stimulatory fillers. Unlike hyaluronic acid (HA) fillers, which draw water and often require frequent touch-ups, bio-stimulatory options like Sculptra , Bellafill , and Radiesse offer long-lasting benefits. Here’s why:
- Collagen Stimulation : These fillers trigger your body’s natural collagen production, leading to gradual and sustainable improvements.
- Natural Results : They provide soft, undetectable enhancements without the “overfilled” look associated with HA fillers.
- Versatility : Whether you’re dealing with facial balancing or acne scars, these products can be tailored to meet specific needs.
For example, Bellafill contains PMMA microspheres that remain in the tissue permanently, providing structural support while your body builds collagen around them. Meanwhile, Sculptra works more subtly, with effects building over several months.
Addressing Fat Loss in Scarred Skin: The Importance of Volume Restoration
One of the most overlooked aspects of treating acne scars is addressing fat loss. Many patients come to me with significant atrophy, especially if they’ve had severe acne during their teenage years or early adulthood. Fat loss not only makes scars more pronounced but also contributes to an aged appearance. In these cases, simply breaking up scar tissue through subcision isn’t enough—we need to restore lost volume.
This is where bio-stimulatory fillers shine. Products like Bellafill and Sculptra are incredibly effective for replacing lost volume while simultaneously stimulating collagen production. For patients with sufficient donor fat, fat transfers can also be an excellent option. However, not everyone is a candidate for fat grafting, particularly those who are naturally thin or have extensive scarring.
In the case of the patient mentioned earlier, his Fitzpatrick 6 skin type and lack of available fat made bio-stimulatory fillers the ideal choice. By carefully layering microdroplets of Bellafill and Sculptra, we achieved a natural lift and restored youthful contours without overfilling.
Beyond Scars: Managing Hyperpigmentation and Skin Tone Disparities
While acne scars often take center stage in consultations, hyperpigmentation and uneven skin tone are equally important concerns for many patients. Post-inflammatory hyperpigmentation (PIH) is a common side effect of acne, and it can persist long after the scars themselves have healed. Additionally, some patients struggle with areas of their face being darker than others, such as the face appearing several shades darker than the neck or chest.
To address these issues, I use a combination of advanced treatments:
- Pico Lasers : These lasers target pigment cells with precision, breaking down melanin deposits without damaging surrounding tissue.
- Customized Skincare Regimens : Products like retinoids, hydroquinone, and vitamin C serums help lighten dark spots and even out skin tone over time.
- Chemical Peels : Light peels containing glycolic acid or salicylic acid can exfoliate the top layers of the skin, reducing discoloration.
For the patient discussed earlier, pico laser treatments played a crucial role in brightening his complexion and reducing hyperpigmentation along his cheeks. Combined with subcision and bio-stimulatory fillers, this approach delivered comprehensive results that addressed both scarring and pigmentation concerns.
The Role of Subcision in Scar Treatment: Breaking Down the Process
One of the most effective techniques I use in scar treatment is subcision . This minimally invasive procedure involves breaking up fibrous bands of scar tissue that tether the skin, causing it to appear indented or uneven. Subcision can be performed manually using specialized tools like blunt cannulas, Taylor liberators, or Nokor needles. Each tool has its purpose, depending on the depth and type of scar being treated.
For example, in the case of the patient mentioned earlier, subcision was key to releasing tethered scars and allowing the skin to rise naturally. However, subcision alone isn’t always enough. Combining it with volume replacement—such as bio-stimulatory fillers—creates a synergistic effect. The filler provides immediate structural support while stimulating long-term collagen production, leading to smoother, more youthful-looking skin over time.
It’s important to note that subcision requires precision and expertise. Poorly executed subcision can lead to complications such as widened scars, increased tension, or worsening pigmentation. That’s why I always emphasize the importance of choosing a skilled provider who understands the nuances of scar revision.
Addressing Common Concerns About Treatments
Below, I’ve compiled answers to some of the most common questions I received during the live session
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Question : What are your thoughts on beef tallow on TikTok?
Dr. Qazi : I’m open to trying it if it’s pure and not mixed with unnecessary additives. However, I’m cautious about trends pushed heavily through affiliate links without proper evidence. If recommended brands prove safe, I’d consider incorporating them into skincare routines for acne-prone skin. -
Question : What do you think of hyper-dilute collagen bio-stimulators?
Dr. Qazi : I absolutely love them! Products like Sculptra and Radiesse were staples in my early practice when I didn’t have access to energy devices. They’re perfect for stimulating collagen and improving skin quality over time. -
Question : What’s my opinion of salmon sperm injection?
Dr. Qazi : Based on feedback from patients who’ve tried it abroad, I’m skeptical. Many report extreme pain with little to no improvement in their scars. While I might explore it further someday, it’s not something I’m excited about right now. -
Question : Are the results temporary or lifelong since fillers dissolve?
Dr. Qazi : It depends on the filler. Hyaluronic acid fillers dissolve completely, but bio-stimulatory fillers like Bellafill leave behind PMMA particles that continue to stimulate collagen. Even so, aging naturally affects everyone, so maintenance may still be necessary. -
Question : If you had to choose for these scars, which would you recommend: PRP and microneedling with subcision or Radiesse with subcision?
Dr. Qazi : Subcision combined with bio-stimulatory fillers like Radiesse tends to yield better results for deeper scars. However, timing is crucial—I wouldn’t combine both treatments in the same session due to the risk of jowling. -
Question : Also, I recently started spironolactone. Do you know why it takes so long to work? I’ve heard it can take up to three months.
Dr. Qazi : Spironolactone primarily suppresses DHT levels, which requires time to clear from your system. Typically, patients start seeing results after two to three months. -
Question : Is it true that the skin can never go back to how it was before the scars without reinjecting with bio-stimulatory fillers?
Dr. Qazi : In cases involving significant fat loss, reinjection with bio-stimulatory fillers or fat transfers may be necessary. However, treatments like TCA cross and subcision can also improve appearance without additional injections. -
Question : What do you think of microneedling with exosomes?
Dr. Qazi : While it has potential for anti-aging purposes, I don’t recommend it for scars. Patients are often misled into thinking it will solve deeper scar issues when it rarely does. -
Question : Do you do fat transfers? Would anyone with lots of acne scars be a candidate?
Dr. Qazi : Yes, I perform fat transfers for eligible candidates. However, this option depends on whether the patient has enough donor fat available. -
Question : Is Bellafill safe, and how many syringes for cheeks only?
Dr. Qazi : Bellafill is safe when injected carefully. For cheeks, I use microdroplets initially and wait months between sessions to ensure optimal placement and avoid overfilling. -
Question : Do acne scars instantly fill with Bellafill?
Dr. Qazi : Initially, yes, but the cow collagen in Bellafill absorbs within one to three months. Afterward, your body forms new collagen around the PMMA particles, resulting in gradual improvement. -
Question : Which product do you recommend best for severe back acne?
Dr. Qazi : Severe back acne often requires medical intervention, such as oral antibiotics, sulfur-based creams, or Accutane. Topical retinoids like Aclaret can also help, though they’re expensive. -
Question : You mentioned using a laser to reduce sebaceous gland activity. Can this dry out the skin?
Dr. Qazi : Not typically. With proper care, treatments like the Accure laser normalize oil production without causing excessive dryness. -
Question : Do you think TCA subcision will become more popular in other states? It’s so hard to find doctors in other states that do this.
Dr. Qazi : Absolutely. More practitioners are recognizing the importance of precision and technique in performing subcision safely and effectively. -
Question : How many punch excisions is too many?
Dr. Qazi : It’s not about quantity but location. Multiple excisions along the same tension line heal predictably, whereas clustered excisions increase tension and scarring risks. -
Question : Doctor, can I purchase more of your pigmentation cream once I’m out and use it regularly?
Dr. Qazi : Of course! Reach out to our office, and we’ll send more your way. -
Question : What would you recommend for mild-to-moderate ice pick and boxcar scars?
Dr. Qazi : TCA cross is highly effective for these types of scars. For boxcar scars, small amounts of Bellafill can complement the treatment. -
Question : My face is three shades darker than my neck and chest. Is it possible to lighten my face?
Dr. Qazi : Absolutely. Using pico lasers and specialized creams, we can even out pigmentation differences effectively. -
Question : Can you get a facelift if you’ve done Sculptra?
Dr. Qazi : Yes, provided the Sculptra was placed correctly. Microdroplet techniques minimize interference with surgical procedures.
Final Thoughts
Treating acne scars and pigmentation issues is both an art and a science. By combining advanced techniques like subcision, bio-stimulatory fillers, and TCA cross treatments, I aim to restore confidence and enhance natural beauty. Remember, every patient’s journey is unique, and there’s no one-size-fits-all solution. If you’re struggling with similar concerns, don’t hesitate to reach out—we’re here to help.
To learn more about our services or schedule a consultation, visit doctorqazi.com . Let’s work together to achieve the radiant, healthy skin you deserve!
