As a skin restoration specialist based in Newport Beach, California, I focus on helping patients overcome some of the most challenging skin concerns—acne scars, pigmentation issues, hyperpigmentation, and facial asymmetry. My practice is built around customizing treatments for each patient’s unique skin type, lifestyle, and goals. Today, I want to walk you through a recent case that illustrates how my approach works in real life. This patient, who has Fitzpatrick 6 skin (African descent), came to me with deep acne scars and significant pigmentation challenges. Over several months, we achieved remarkable results without relying on aggressive laser treatments. Let me share the details and explain why this case is so rewarding. I will talk about subcision, volume replacement with bellafill and sculptra, and much more.
The Case Study: A Fitzpatrick 6 Patient with Deep Acne Scars. Bellafill, Sculptra and more.
This patient first visited me in November 2024. His skin was marked by deep ice-pick scars, boxcar scars, and extensive pigmentation caused by years of severe cystic acne. Many practitioners had told him his scars were untreatable or recommended ineffective treatments like micro-needling packages. He felt hopeless and frustrated. But when he walked into my office, I knew there was hope.
I took a comprehensive approach, combining subcision, TCA cross, volume replacement with Bellafill and Sculptra, and PicoSure laser for pigmentation. Importantly, I avoided using energy-based devices like CO2 lasers because they can sometimes complicate healing, especially in darker skin tones. Instead, I focused on manual techniques that stimulate collagen production, break up scar tissue, and restore volume safely.
By April 2025, just five months later, the transformation was incredible. The patient’s skin quality improved dramatically, and his confidence soared. While there’s still room for refinement, the progress speaks volumes about what’s possible when we tailor treatments thoughtfully.
Why I Avoided Lasers in This Case
One of the key decisions I made was not to use lasers during this treatment journey. Why? Because lasers aren’t always necessary—and sometimes they’re counterproductive. For darker skin types like Fitzpatrick 6, lasers carry risks of hyperpigmentation and prolonged healing times. In this case, I opted for safer alternatives such as:
- Subcision : Using specialized tools like Taylor Liberators, Nokor needles, and blunt cannulas, I broke up the tethered scar tissue beneath the skin.
- TCA Cross : This chemical peel technique targets individual scars, triggering collagen production at the base of the scar.
- Volume Replacement : Bellafill and Sculptra helped rebuild lost fat and provide structural support where the skin had collapsed due to scarring.
- PicoSure Laser : For pigmentation issues, I used this low-heat laser to gently address discoloration without damaging the surrounding skin.
The combination of these methods allowed us to achieve outstanding results while minimizing risks.
Customization Is Key
One of the biggest misconceptions in dermatology is the idea of “cookie-cutter” treatment plans. You’ve probably heard phrases like, “You need six sessions of microneedling,” or “CO2 laser is the only solution.” These blanket statements ignore the complexity of individual cases. Every patient’s skin responds differently based on factors like genetics, diet, sun exposure, and even stress levels.
For example, South Korean women often show faster recovery and better collagen responses compared to other ethnic groups. However, I believe much of this difference comes down to lifestyle habits, including strict sun protection and anti-inflammatory diets. That’s why I emphasize holistic care with all my patients. If you want killer results, you need to commit to healthy habits alongside your treatments.
Treating Different Ethnicities Safely
People often ask whether certain skin types respond better to specific treatments. While everyone’s skin behaves uniquely, I’ve found that certain principles hold true across ethnicities:
- Arab Skin : Similar to Fitzpatrick 6 skin, Arab skin requires careful handling to avoid pigmentation issues. Manual techniques like subcision and TCA cross work exceptionally well here.
- Korean Skin : Despite appearing lighter, many Korean patients are prone to rebound pigmentation after laser treatments. Precision and caution are critical.
- South Asian Skin : Even pale-skinned individuals within this group may experience hyperpigmentation if treated improperly. Genetics play a larger role than skin tone alone.
No matter the ethnicity, the goal is always the same: safe, effective treatments tailored to the patient’s needs.
Questions Answered
Here are answers to some common questions I received during the live session:
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Question: I noticed you recommend Botox for a patient that has something that can't be done at the same time as the treatment.
Dr. Qazi: It depends on the area being treated. For example, if we’re addressing forehead wrinkles or crow’s feet, Botox can often be done the same day. However, if the treatment involves subcision or other procedures that cause inflammation, I might delay Botox to ensure proper healing. -
Question: How soon after TCA cross did you see results, and how many times did you do TCA cross and after how long?
Dr. Qazi: Results from TCA cross typically start appearing after a few weeks, but full improvement takes several months. In this particular case, we performed three to four sessions spaced out over several months. -
Question: Thoughts on Bellafill under the eye specifically tear trough filling?
Dr. Qazi: Bellafill can be used near the orbital rim, but it must be done cautiously. I wouldn’t recommend placing it too close to the tear trough itself due to its permanence. Proper technique is essential to avoid complications. -
Question: Do you see more improvement in people with different ethnicities?
Dr. Qazi: Yes, improvements vary depending on factors like genetics, diet, and skincare habits. Some ethnicities tend to heal faster, but the ultimate outcome depends on the patient’s commitment to the process. -
Question: For out-of-town patients, how long would we have to wait to do volume replacement like Bellafill after initial treatments like subcision, lasers, and peels?
Dr. Qazi: It depends on the area being treated. For upper facial areas like the temples, I may perform volume replacement the same day. However, for lower facial areas, I prefer waiting until the initial treatments settle. -
Question: What would you do for a scar on the perioral mound—the fat blob next to the mouth—that has flattened and created asymmetry?
Dr. Qazi: Subcision might help release tethered scar tissue, followed by a softer hyaluronic acid filler. Products like Restylane work well here, avoiding collagen-stimulating fillers that could cause thickening. -
Question: What treatment for acne scars with melasma?
Dr. Qazi: Melasma requires a delicate touch. We might use subcision, TCA cross, or low-heat erbium lasers sparingly, focusing on localized spots rather than bulk heating. -
Question: Would you recommend fat grafting before or after subcision?
Dr. Qazi: Always subcision first. Breaking up scar tissue ensures the grafted fat integrates properly. -
Question: In what instances would Sculptra be recommended instead of Bellafill?
Dr. Qazi: Sculptra is ideal for patients with significant volume loss who prefer a temporary solution. Bellafill suits those seeking long-term results but requires comfort with permanence. -
Question: I just got Bellafill; I love it! Is there any aftercare I have to do?
Dr. Qazi: Keep it simple—don’t massage or manipulate the treated area, and apply ice for a couple of days to reduce swelling. -
Question: I have large pore openings on my nose; how can it be treated?
Dr. Qazi: These are likely ice-pick scars. TCA cross is highly effective, as it triggers collagen production to tighten the pores. -
Question: How would I know if I have tear troughs or just skin burn from eye rubbing?
Dr. Qazi: Gently pull down your lower eyelid. If the pigmentation moves with it, it’s likely related to the skin rather than deeper tear troughs.
Final Thoughts
Treating acne scars and pigmentation is both an art and a science. By combining advanced techniques with personalized care, I aim to empower my patients to feel confident in their skin. Whether you’re local or traveling from afar, I’m committed to guiding you through every step of your journey.
If you’re ready to take control of your skin’s future, visit my website at doctorqazi.com to schedule a consultation. Together, we’ll create a plan that delivers the results you deserve.
