Hi everyone, I’m Dr. Qazi, a skin restoration specialist based in Newport Beach, California. My practice focuses on treating acne, scars, pigmentation, and collagen stimulation, with a particular emphasis on helping patients with melanated skin—Fitzpatrick 4 and above. Over the years, I’ve developed a reputation for delivering safe, effective results for darker skin tones. Today, I want to walk you through one of my most rewarding cases, share insights into my methods, and answer some common questions about treating acne scars and pigmentation in diverse skin types.
Treating Scars and Pigmentation in Melanated Skin
One of the most frequent questions I get is how we can treat scars and pigmentation safely in darker skin tones. The truth is, there are many options beyond just lasers. While lasers can be an effective tool, they’re not always necessary, especially when treating Fitzpatrick 4+ skin. Instead, I often rely on manual treatments like subcision, TCA Cross, and Bellafill to achieve incredible results.
Let me share a recent case that highlights this approach. A patient from New Orleans came to me with deep rolling scars. After several sessions of subcision, Bellafill, and TCA Cross, his results have been nothing short of phenomenal. It’s now almost impossible to see many of his scars. In fact, during a virtual follow-up, he reported that his skin looked even better after additional treatments. This type of progress is incredibly rewarding because it proves that patients with melanated skin don’t need to settle for subpar care or risky treatments.
For those unfamiliar, here’s a quick breakdown of the techniques I used:
- Subcision : This involves breaking up fibrous scar tissue beneath the skin using a specialized needle. It helps release tethered scars and allows the skin to heal more smoothly.
- Bellafill : A long-lasting dermal filler containing bovine collagen and polymethylmethacrylate (PMMA) microspheres. It provides immediate volume while stimulating your body’s natural collagen production over time.
- TCA Cross : A high-concentration trichloroacetic acid applied directly to icepick or boxcar scars. It triggers collagen remodeling and improves texture without affecting surrounding skin.
These methods work beautifully together, especially for patients who want minimal downtime and reduced risk of post-inflammatory hyperpigmentation (PIH).
Why Ultrasound Is a Game-Changer
One tool I’ve come to rely on heavily is ultrasound imaging. Many people don’t realize how transformative ultrasound can be in aesthetic medicine. For example, when working on the patient mentioned earlier, I used ultrasound to assess whether certain areas required further treatment. Was it true scar tissue? Fat loss? Or something else entirely? The detailed images allowed me to pinpoint exactly where to focus my efforts.
Ultrasound isn’t just for diagnostics; it’s also invaluable for dissolving fillers if needed. If a patient has had silicone injections or another product causing issues, ultrasound-guided dissolution ensures precision and safety. Not enough practitioners utilize this technology, but I believe it’s essential for delivering consistent, predictable outcomes.
The Importance of Tailored Treatments for Rolling Scars
One of the most common types of scars I encounter is rolling scars, which appear as wave-like depressions across the skin. These scars often result from fibrous bands pulling the skin downward. Subcision is particularly effective for these scars because it physically breaks those bands, allowing the skin to rise and heal naturally.
In some cases, I combine subcision with Bellafill to provide both immediate volume and long-term collagen stimulation. For example, I recently treated a patient whose rolling scars were so severe that they caused significant textural irregularities. After two sessions of subcision and Bellafill, the improvement was dramatic. His skin became smoother, and the scars were far less noticeable.
This tailored approach underscores the importance of understanding each patient’s unique anatomy and concerns. Rolling scars require a different strategy than icepick or boxcar scars, which is why I spend so much time analyzing scar patterns before recommending a treatment plan.
Managing Post-Treatment Care and Expectations
Post-treatment care is just as critical as the procedure itself. Patients often ask me about skincare routines after procedures like phenol peels or laser treatments. My advice is simple: keep it gentle. Over-exfoliating or using harsh products can exacerbate irritation and delay healing.
For the first few months after a phenol peel, I recommend sticking to a basic regimen:
- Sunscreen : Non-negotiable. Sun protection is crucial to prevent PIH, especially for Fitzpatrick 4+ skin.
- Moisturizer : Use a lightweight, non-comedogenic moisturizer to maintain hydration without clogging pores.
- Retinoids : Start with a low-dose tretinoin mixed with a moisturizer. Gradually increase strength as your skin tolerates it.
I also emphasize patience. Collagen remodeling takes time, and results from treatments like Bellafill or subcision may not be fully visible for several months. Managing expectations is key to ensuring patients stay committed to their treatment plans.
Questions Answered
Here are answers to some of the questions I received during the live session:
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Question: Hey Dr. Qazi, I started getting dark circles and eye bags after Accutane. Any recommendations on how to get rid of them?
Dr. Qazi: Post-inflammatory hyperpigmentation due to sun sensitivity is likely the culprit. Start with diligent sun protection—wear a broad-spectrum sunscreen daily. You can also apply Eucerin Anti-Pigment Cream along the bony orbital rim in the mornings. Be cautious not to let it migrate into your eyes, though. -
Question: What’s the worst-case scenario with subcision?
Dr. Qazi: Swelling is the primary concern, but it’s usually temporary. In rare cases, swelling may last up to three months, especially for patients with severe scarring. However, with proper care, including massage and monitoring, complications are minimal. -
Question: What’s the most Bellafill sessions that you gave to somebody on the temples spread out?
Dr. Qazi: Typically, patients require four to six vials total, administered gradually. For extensive temple hollowing, I might use six to eight vials, but this is on the higher end of the spectrum. -
Question: Do you ever recommend excision? Some clients say it made their scars worse. What do you think?
Dr. Qazi: Excision can be controversial. I only recommend it for specific scar types located along Langer’s lines to minimize tension. For other scars, less invasive methods like subcision or TCA Cross often yield better results. -
Question: TCA Cross versus TCA chemical peel—what’s better?
Dr. Qazi: TCA Cross is far superior for targeting individual scars. You can use a much higher concentration directly on the scar, triggering a precise collagen response. Chemical peels, on the other hand, are better for overall skin resurfacing. -
Question: Is a keloid scar from acne on the chest treatable?
Dr. Qazi: Yes, it’s treatable. We typically reduce inflammation with steroid injections and then use silicone tape to flatten the scar over time.
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Question:Â Did you ever personally struggle with acne?
Dr. Qazi:Â Absolutely. I dealt with severe cystic acne as a teenager and underwent three rounds of Accutane. My experience fuels my passion for helping others struggling with acne today. -
Question:Â What do you recommend for scars on the labia post-vaginoplasty?
Dr. Qazi: For this delicate area, I use a fractional erbium laser. It’s gentler than CO2 and avoids excessive drying. Patients must avoid sexual activity for about two weeks to ensure proper healing. -
Question:Â What do you recommend for skincare after a phenol peel and as a general routine?
Dr. Qazi:Â For the first few months post-peel, keep it simple. Use a gentle pigmentation cream initially, then slowly introduce a low-dose retinoid like tretinoin mixed with a moisturizer. Avoid over-exfoliating, especially for Asian skin types. -
Question:Â Is Tazorac better or tretinoin for acne or skin aging?
Dr. Qazi: I prefer low-dose tretinoin for most patients. It’s gentler and less likely to irritate the skin compared to Tazorac, which can be too harsh for acne-prone skin. -
Question:Â What are your thoughts on the oil cleansing method?
Dr. Qazi: I personally use an oil cleanser (a Korean brand called Solasu), and it works well for my skin. However, I’m cautious about recommending it for acne-prone skin since everyone’s reaction may vary. -
Question:Â What do you think of Endolift?
Dr. Qazi: While Endolift has its merits, I’m skeptical about its efficacy without accompanying liposuction. The melted fat can sometimes harden, leading to uneven results.
Final Thoughts
Treating acne scars and pigmentation in melanated skin requires a tailored, thoughtful approach. By combining advanced techniques like subcision, Bellafill, and TCA Cross with cutting-edge tools like ultrasound imaging, I’ve been able to help countless patients achieve life-changing results. If you’re considering treatment, remember that patience and consistency are key. Every skin type is unique, and finding the right combination of therapies can make all the difference.
Thank you for joining me today! If you have more questions or would like to schedule a consultation, feel free to reach out. Together, we can restore your confidence and help you embrace your best skin yet.
