Acne Scars, Subcision, CO2 Laser- April 14th 2025

Hi everyone, I’m Dr. Qazi, and I specialize in skin restoration at my clinic in Newport Beach, California. My focus is primarily on treating acne scars, pigmentation issues, and stimulating collagen to rejuvenate the skin. Today, I want to walk you through a remarkable case that truly showcases the transformative power of personalized skincare. We performed subcision, excision, bellafill, TCA Cross and laser resurfacing. This patient’s journey over less than a year has been nothing short of extraordinary, and it exemplifies how we can achieve natural, youthful results through careful planning and execution.

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A Case Study in Skin Restoration

This particular patient came to me seeking help for deep acne scars and significant volume loss, especially around the temples. He is in his late 20s and of Asian descent. His skin type required us to be exceptionally cautious, as it is more sensitive and prone to hyperpigmentation. Our goal was clear: restore lost volume while ensuring the results looked entirely natural. Over the course of about six months, we implemented a multi-step approach involving subcision, excision, Bellafill injections, TCA cross, and laser resurfacing.

The transformation has been remarkable. Not only have his scars improved dramatically, but he also appears significantly younger. The temple area, which was once hollowed out due to fat loss, now looks fuller and more balanced. Even the wide boxcar scars on his forehead have softened considerably. This case underscores the importance of addressing both structural and surface-level issues to achieve comprehensive skin rejuvenation.

Expanding on Treatment Modalities. Subcision, Bellafill, Laser, TCA Cross.

Subcision and Excision

Subcision is one of the most effective techniques for releasing tethered scar tissue. By breaking up the fibrous bands beneath the skin, we allow the surface to rise and heal more evenly. In this patient’s case, I performed tailored liberator subcision to target specific areas. Additionally, excision was necessary for some larger scars, particularly those on the mid-cheek. Removing these scars entirely provided a smoother canvas for further treatments.

Bellafill Injections

Bellafill is a game-changer for long-term volume replacement. Unlike temporary fillers like hyaluronic acid, Bellafill contains PMMA microspheres that stimulate your body’s own collagen production. For this patient, Bellafill helped rebuild the lost volume in a way that looks and feels natural. We will continue to monitor and potentially add more Bellafill in the future to maintain optimal results.

Laser Resurfacing and TCA Cross

Laser resurfacing and TCA cross are essential for refining texture and reducing the appearance of scars. These procedures work by promoting new collagen growth and smoothing out uneven surfaces. While lasers address broader areas, TCA cross targets individual deep scars with precision. Together, they create a harmonious blend of smoothness and radiance.

Understanding Skin Types and Customized Treatments

One crucial aspect of skin restoration is understanding different skin types and tailoring treatments accordingly. As seen in this case, our patient had Fitzpatrick Type 4 skin, which requires meticulous care to avoid hyperpigmentation. Using lower energy settings and precise techniques ensures safety and effectiveness. Devices like Excel V and Vbeam are preferred for vascular concerns due to their lower heat and energy outputs, minimizing risks of rebound hyperpigmentation.

Incorporating various modalities such as microneedling, PRP (Platelet-Rich Plasma) injections, and even oral medications like minoxidil helps address underlying issues contributing to skin health. Regular monitoring and adjustments based on individual responses ensure the best outcomes. For instance, combining Accutane with low-dose spironolactone can effectively manage excessive oil production, creating a stable foundation for subsequent treatments.

Holistic Approach to Skin Health

Beyond procedural interventions, maintaining overall skin health involves lifestyle modifications and nutritional support. Vitamin D levels, thyroid function, and anemia must be assessed and managed to optimize healing and prevent further complications. Patients often overlook these factors, yet they play a pivotal role in achieving lasting improvements.

For hair loss, integrating PRP injections alongside oral minoxidil offers promising results. Topical solutions may not suffice alone; however, combining them with systemic approaches yields better outcomes. Personal anecdotes from my practice illustrate the efficacy of this combined strategy—patients notice substantial improvements within months.

Additionally, managing expectations and educating patients about post-treatment care cannot be overstated. Avoiding makeup during recovery phases allows the skin to breathe and heal naturally. Emphasizing sun protection and gentle skincare routines reinforces the longevity of treatment benefits. This holistic approach ensures patients remain comfortable and confident throughout their journey.

Addressing Common Concerns and Questions

Below, I’ve compiled answers to some of the questions that I got during my live session:

• Question: Thoughts on Radiesse versus HA for subcision?
  Dr. Qazi: I typically perform subcision using tumescent fluid (lidocaine with epinephrine) to numb and prepare the area. While some practitioners use Radiesse immediately after subcision, I prefer to space out treatments to avoid complications such as heaviness or improper layer placement. Localized spot treatments with Sculptra or Bellafill may be considered separately.
• Question: If you need subcision but did lasers first, will you get any benefit?
  Dr. Qazi: Absolutely! Both subcision and lasers serve different purposes and can complement each other. Even if you’ve had laser treatments, subcision can still provide substantial benefits by releasing trapped scar tissue.
• Question: I'm 20; if I get polynucleotides injections, will it smoothen my acne scars on my face or microneedling?
  Dr. Qazi: Polynucleotide injections like Rejuran might improve overall skin quality but aren’t particularly effective for acne scars. Microneedling alone isn’t sufficient either. For significant improvement, consider combining treatments like subcision, TCA cross, and possibly Bellafill.
• Question: What procedure was performed on this patient?
  Dr. Qazi: We utilized a combination of subcision, excision, Bellafill injections, TCA cross, and laser resurfacing to address various aspects of scarring and volume loss.
• Question: Is this covered by insurance, especially acne scars?
  Dr. Qazi: Unfortunately, in the U.S., acne scar treatments are generally not covered by insurance. However, countries like Australia do offer coverage. Keep advocating for change!
• Question: Do you do any procedures for hair loss as well?
  Dr. Qazi: Yes, we offer PRP (Platelet-Rich Plasma) injections, which I personally use on my scalp. Combined with oral minoxidil and proper nutrition (like maintaining adequate vitamin D levels), PRP can effectively stimulate hair growth.
• Question: Can you treat chickenpox scars with the same procedure as acne scars?
  Dr. Qazi: Yes, though chickenpox scars may require additional modalities on their depth and width. Excisions and subcision can be highly beneficial.
• Question: Can you treat ice pick scars sometimes? I think it looks too deep to be resurfaced.
  Dr. Qazi: Ice pick scars can indeed be challenging, especially in darker skin types. Subcision, TCA cross, and strategic excisions often yield better results than aggressive laser treatments, which can cause further damage.
• Question: How long is a normal recovery for the acne scar treatment regarding very severe acne icepick scars?
  Dr. Qazi: Typically, patients recover within four to seven days. More intensive treatments like phenol peels require about 12 days of recovery.
• Question: Phenol peel recovery?
  Dr. Qazi: Recovery from a phenol peel involves approximately 12 days, during which you should avoid talking and stick to a liquid diet. Proper post-treatment care, including sun protection, is crucial.

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• Question: I have mostly rolling scars and hyperpigmentation. I’ve done VI peel and 1550 Fraxel. What’s next?
  Dr. Qazi: Consider subcision and volume replacement. Virtual consultations can help determine the best course of action tailored to your specific needs.
• Question: Hi doctor, is a vascular laser like Vbeam or Derma V safe and effective for PIE on darker skin?
  Dr. Qazi: Excel V is preferable for darker skin types due to its lower heat and energy settings, minimizing the risk of rebound hyperpigmentation.
• Question: Do you recommend CO2 for red hypertrophic surgical tummy scars or just VBeam and steroid or all together and which order?
  Dr. Qazi: Start with a vascular laser like VBeam or Excel V followed by steroids. CO2 laser is reserved for thicker textures.
• Question: Updates on verteporfin?
  Dr. Qazi: Feel free to send images of body scars for review. We’re actively researching innovative solutions like verteporfin.
• Question: How could I treat a small third-degree burn scar from six years ago?
  Dr. Qazi: Depending on the complexity, options include laser therapy for texture improvement and subcision/volume replacement for indented areas.
• Question: Does Botox make fillers last longer for necklace lines, gobella, etc.?
  Dr. Qazi: Yes, Botox reduces movement, enhancing filler longevity and overall results.
• Question: Do you recommend subcision for fibrotic tissue underneath the scar in the labia majora region or what else to do with it as the scar is indented?
  Dr. Qazi: Subcision can be effective here. Alternatively, localized fillers like Bellafill or hyaluronic acid might offer relief.
• Question: So if someone gets filler, how often do they need to get fillers redone?
  Dr. Qazi: It varies. Temporary fillers last several months, whereas Bellafill offers semi-permanent results lasting five years or more.
• Question: Can CO2 laser cause fat loss in the cheeks?
  Dr. Qazi: Theoretically possible but unlikely unless excessively high heat and energy settings are used.
• Question: Can retinoids give you worse skin texture?
  Dr. Qazi: Retinoids can initially dry out the skin, leading to increased oil production. Adjusting the dosage and frequency usually resolves this issue.
• Question: What is the recovery for fractional CO2 laser and how long before I can wear makeup?
  Dr. Qazi: Recovery takes about four to seven days. Makeup can typically be worn after ten days, though avoiding it altogether promotes healthier skin.
• Question: Thoughts on phenol peels for acne scars versus lasers and other modalities?
  Dr. Qazi: Phenol peels excel in tightening and contracting tissue, making them ideal for deeper scars. However, they involve significant downtime and must be approached with caution.

Contact Qazi Cosmetic Center Today

As a dedicated skin restoration specialist, my mission is to empower individuals to feel confident and comfortable in their skin. Through meticulous diagnosis and personalized treatment plans, we can achieve stunning transformations. Whether you’re dealing with acne scars, hair loss, or other dermatological concerns, rest assured there are solutions available. Schedule a consultation today, and let’s embark on your journey to radiant, healthy skin together!