Hi, everyone. I’m Dr. Qazi, a skin restoration specialist based in Newport Beach, California. My passion lies in helping patients with acne scars, pigmentation issues, and facial balancing. Over the years, I’ve developed a unique approach that blends surgical precision with cutting-edge technology to deliver results that truly transform lives. Today, I want to walk you through one of my recent cases, a young man in his 20s who came to me with significant scarring and pigmentation concerns. By sharing this journey, I hope to provide insight into how I tackle complex skin issues while addressing some common questions I receive from patients.
The Case: A Journey of Transformation
When this patient first walked into my clinic, he was dealing with deep acne scars, fat loss, and pigmentation. His Fitzpatrick skin type 4 meant we had to be especially cautious about treatments that could trigger further pigmentation issues. This case required a multi-step process, combining both manual procedures and advanced technologies.
Step 1: Understanding the Problem
Before diving into treatment, it’s crucial to assess the root causes of the scarring. In this case, the patient had experienced significant fat destruction, particularly around the temples and cheeks. Fat loss often exacerbates the appearance of scars, making them appear deeper and more pronounced. Additionally, his scars included boxcar, ice pick, and rolling types, each requiring a tailored approach.
Step 2: Manual Procedures
We started with an elliptical excision to remove wider scars, converting them into narrower, more superficial scars. This technique is ideal for larger, more visible scars because it creates a linear scar that heals better over time. We also performed subcision, a procedure where I use specialized tools to break up fibrous scar tissue beneath the skin. Subcision helps lift depressed scars but doesn’t address volume loss—something many practitioners overlook.
Step 3: Laser Treatments
For the thicker parts of the scars, I employed a CO2 laser to resurface the skin. The CO2 laser works by vaporizing damaged skin layers, promoting collagen production, and smoothing out uneven textures. Given the patient’s Fitzpatrick 4 skin type, I exercised extreme caution to avoid triggering pigmentation. In certain areas, I combined the CO2 laser with TCA Cross, a chemical treatment applied directly to individual scars to dissolve their edges.
Step 4: Volume Replacement
Fat loss was a major concern for this patient, so I incorporated Bellafill, a biostimulatory filler, to restore lost volume. Unlike temporary fillers like hyaluronic acid, Bellafill stimulates your body’s natural collagen production, providing long-lasting results. It’s particularly effective for scarred areas, as it supports the skin structure without causing additional pigmentation issues.
Step 5: Follow-Up Care
Six to eight months post-treatment, the patient showed remarkable improvement. His scars were significantly reduced, and his overall skin texture had improved dramatically. However, the journey isn’t over yet. To achieve optimal results, we’ll continue with periodic touch-ups, including additional laser sessions and targeted treatments for stubborn scars.
Advanced Techniques and Tools
In treating complex cases like this, several advanced techniques and tools play pivotal roles:
Elliptical Excision
Elliptical excision is a precise surgical technique used to remove larger scars. By excising the scar and closing the wound in a linear fashion, we create a more aesthetically pleasing result that heals better over time.
Subcision
Subcision involves breaking up the fibrous bands that tether scars to deeper tissues. While effective for lifting scars, it must be combined with volume replacement strategies to prevent the skin from sinking back down due to fat loss.
CO2 Laser Resurfacing
The CO2 laser is a powerful tool for resurfacing the skin. It removes damaged layers, promotes collagen production, and smooths out textures. However, its use on darker skin tones requires careful handling to avoid hypopigmentation or worsening scars.
TCA Cross
Trichloroacetic acid (TCA) Cross targets individual scars by applying a high concentration of acid directly to the base of each scar. This method dissolves scar edges, promoting smoother skin texture.
Biostimulatory Fillers
Fillers like Bellafill and Sculptra are invaluable for restoring lost volume. These fillers stimulate natural collagen production, offering long-term benefits without triggering pigmentation issues.
The Importance of Customization
One size does not fit all when it comes to treating acne scars and pigmentation. Each patient presents unique challenges that require personalized solutions. Here’s why customization matters:
- Skin Type Considerations : Patients with Fitzpatrick 4 or higher skin types are prone to hyperpigmentation. Aggressive treatments can worsen these issues, necessitating a more conservative approach.
- Scar Types : Different scars respond differently to treatments. Boxcar, ice pick, and rolling scars each demand specific techniques to achieve optimal results.
- Volume Loss : Significant fat loss requires volume replacement to support the skin structure adequately. Ignoring this aspect can undermine the effectiveness of other treatments.
Preventing Future Scars and Pigmentation Issues
Prevention is always better than cure. Here’s how you can minimize the risk of future acne scars and pigmentation problems:
- Control Active Acne : Effective acne management reduces the likelihood of new scars forming. Use non-comedogenic products and maintain a consistent skincare routine.
- Oil Control : Excessive oil production can exacerbate acne. Incorporating oil-control measures into your regimen can help keep breakouts at bay.
- Regular Skincare Maintenance : Consistent use of retinoids and pigmentation-suppressing creams can prevent new marks from forming.
The Role of Technology in Skin Restoration
Technology plays a crucial role in modern dermatology. Innovative devices offer new possibilities for skin restoration:
- PicoSure Laser : Ideal for treating melasma and post-inflammatory hyperpigmentation, the PicoSure laser delivers impressive results, especially when used gradually on darker skin types.
- Vbeam and XLV Lasers : These devices are excellent for addressing red acne marks and vascular issues. Their contact cooling features make them safer for darker skin tones.
Questions Answered
Here are answers to some frequently asked questions based on my experience and expertise:
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Question: Hydroquinone hasn't worked for my dark shading around my mouth. What else can I do?
Dr. Qazi: Dark shading around the mouth often stems from hormonal factors, such as melasma. Instead of relying solely on hydroquinone, consider alternatives like triple creams (e.g., Triluma) or oral tranexamic acid. Lasers like PicoSure can also be highly effective, though they require careful handling to avoid worsening pigmentation. -
Question: If a hyperpigmentation mark isn’t gone after six months, is it permanent?
Dr. Qazi: Not necessarily. Hyperpigmentation marks may persist if the right treatments haven’t been applied. For instance, combining topical retinoids with Eucerin Anti-Pigment Cream can suppress pigmentation effectively. Patience and persistence are key. -
Question: Why does subcision sometimes cause sagging, and how can I avoid it?
Dr. Qazi: Sagging typically occurs when subcision is performed too superficially or with sharp tools in delicate areas like the lower face. To minimize risks, ensure the procedure is done by an experienced practitioner familiar with anatomical landmarks. -
Question: Does retinol get rid of dark circles?
Dr. Qazi: Retinol might actually worsen dark circles by increasing sun sensitivity and triggering hyperpigmentation. Instead, focus on treatments like radiofrequency microneedling or laser therapies specifically designed for under-eye rejuvenation. -
Question: Do you like the PicoSure laser for pigmentation?
Dr. Qazi: Absolutely! The PicoSure laser is excellent for treating melasma and post-inflammatory hyperpigmentation. However, darker skin types require a gradual approach to prevent adverse reactions. -
Question: Have you ever done fully ablative laser on darker skin types for full-face treatment?
Dr. Qazi: No, I wouldn’t recommend fully ablative lasers for full-face treatments, especially on darker skin. These procedures carry high risks of hypopigmentation and scarring. Localized treatments are safer and equally effective. -
Question: What do you recommend for people of color with acne scars and dark marks?
Dr. Qazi: Start by controlling active acne and oil production. Then, combine treatments like subcision, TCA Cross, and PicoSure laser with biostimulatory fillers like Bellafill or Sculptra to address both scarring and pigmentation. -
Question: Is phenol peel safe?
Dr. Qazi: Phenol peels come with risks, including cardiac toxicity during the procedure. They should only be performed under strict medical supervision and reserved for severe scarring cases. Safer options like focal CO2 laser often produce comparable results. -
Question: What should I do to prevent future acne scars?
Dr. Qazi: Prevention starts with managing acne effectively. Use non-comedogenic products, maintain a consistent skincare routine, and seek professional help early to minimize scarring risk. -
Question: Does phenol peel have side effects on the heart?
Dr. Qazi: Yes, phenol peels can cause arrhythmias during the procedure. That’s why I always monitor patients’ hearts closely using anesthesiologists during treatment. -
Question: Is CO2 required in addition to subcision for minimal acne scarring?
Dr. Qazi: Not necessarily. Depending on the severity of the scars, other modalities like fractional lasers or even volume replacement alone might suffice. -
Question: Which laser is best for red acne marks and some deeper scars?
Dr. Qazi: Vbeam and XLV lasers are great choices for red marks, thanks to their contact cooling features. For deeper scars, CO2 lasers remain the gold standard. -
Question: Is dissolving filler dangerous?
Dr. Qazi: Dissolving filler is generally safe, especially when performed under ultrasound guidance. It’s far better than leaving displaced filler, which can stretch the skin unnaturally. -
Question: Does hydroquinone cause rebound hyperpigmentation, and do you have to use it for life?
Dr. Qazi: Hydroquinone can indeed cause rebound hyperpigmentation if used improperly. Transitioning to alternatives like Eucerin Anti-Pigment Cream combined with topical retinoids offers a sustainable solution.
Final Thoughts
Treating acne scars and pigmentation issues is both an art and a science. Every patient is unique, and success hinges on tailoring treatments to individual needs. Whether it’s through precise surgical techniques, advanced laser therapies, or innovative fillers, my goal remains the same: to empower patients to feel confident in their skin.
If you’re struggling with similar concerns, don’t hesitate to reach out. Together, we can create a personalized plan to help you achieve the smooth, radiant complexion you deserve. Visit doctorqazi.com to learn more about our services and schedule a consultation.
