Best way to treat chicken pox scars: laser or peels?

I've been burdened with chicken pox scars ever since I was an adolescent and am finally going to do whatever it takes to lose them for good. I've been reading up on different treatments to deal with them and am a little conflicted on what makes the most sense of for me. Could you please explain the pros and cons of both peels and fillers to treat this type of scar? As it is I'm really confused and want to be as prepared as I can be when I go for my first consultation with a provider. Thanks.

earlypassenger

F, 35, Michigan

Hi there!

 

Atrophic scars, like the “chicken pox” scars you’re likely suffering from, are subtly concave and make up a large part of some of the more difficult issues to treat in aesthetic medicine. There is no simple approach to treating these kinds of “dug out” scars, but it is important to know what options predominate as the most appropriate treatments.

In our office, we treat each patient individually based on their severity, skin type/tone, overall goals, and financial limitations. In order of least expensive and least downtime/risk to most expensive and greater downtime/risk, I've made a list of some common treatments and procedures used in our office and in many other dermatologic and plastic surgery offices around the country. It is important to note that less expensive and lower risk options may not produce the results you desire, but can help to make improvements and the greatest changes in combination with more aggressive therapies.

 To help you with your research, I’ve listed some of the options we offer in our Montclair, NJ office:

  • Prescription retinoids
    1. Known for rapidly aiding cellular turnover, retinoids (like tretinoin and tazarotene) help to slowly and subtly improve fine textural abnormalities.
    2. Most known to cause dry skin, flaking, and redness that is usually temporary with initial use.
    3. Not all insurance plans cover retinoids for various reasons, so checking with your plan first may be a good idea.
      1. For those individuals not covered, we offer Skin Medica’s Retinol Complex which provides prescription strength at a cost typically lower than purchasing the generic through your pharmacy.
  • Exfoliating AHA and/or BHA cleansers
    1. Alpha Hydroxy Acids and Beta Hydroxy Acids are used in chemical peels, as well as cleansers, to help improve skin texture, tone, and damage.
    2. Nightly or even less frequent use is typically recommended to avoid dryness
    3. Common acids used are Glycolic, Salicylic, and Lactic acids.
  • Chemical peels
    1. Entire books can be written about these types of approaches to skin care in general, but in simpler terms peels are not what you see on “youtube” fails when done by properly trained providers and offer incredible results to our patients.
    2. Peels are broken up in three general categories: superficial, medium, and deep, each relating to the depths of which they penetrate the skins layers.
      1. Likely for your needs, a medium depth peel such as the VI Peel we offer would be a good idea to research and may be a starting point you will want to discuss with your aesthetic medicine provider.
    3. Multiple peels are required to achieve best results, and the frequency of those peels depends on their strength/depth and provider’s preferences.
    4. Most common side effects of peels are redness and dry skin/flaking.
      1. Discuss with your provider any other risks that must be reviewed before undergoing treatment.
    5. Be sure to follow all recommendations made by the provider prior to and after the peel for optimal results and low risk for side effects.
  • Radiofrequency with Microneedling
    1. This is one of the more exciting/newer machines we have in our office with some fantastic results for atrophic scars caused by acne and the like.
      1. We use “Intracel” in our office and we have seen great outcomes for our patients with substantial scarring.
        1. We also use it for stretch marks, raised/wide scars, and skin tightening/rejuvenation.
      2. There are minimal risks of this procedure when performed properly with little to no pain with topical or injectable numbing agents (depending on the surface area being treated).
      3. Most patients are slightly red/swollen for 2-24 hours after the procedure is performed.
      4. Again, like chemical peels, this procedure must be performed multiple times to achieve the desired goal.
  • Laser treatment
    1. We use Fraxel Restore as a laser treatment for atrophic scars.
    2. Patients are topically numbed for about one hour, then the procedure takes about 15 to 20 minutes, depending on the area being treated.
    3. The procedure is performed multiple times on a monthly basis.
    4. Common side effects after the procedure are temporary swelling, redness, or blistering, and can be discussed further with your provider.
    5. This laser can also be used for correcting sun damage, freckles, stretch marks, scars, facial and neck wrinkling, and more.

Good luck to you in your aesthetic journey!

 Dr. Jeanine Downie

I heard that some chicken pox scars do respond well to Fraxel laser treatment. What the laser does, if I understand correctly, is "soften" the tissue behind the scar, and can flatten out some scars that are not too stubborn. Some doctors say they like to start with Fraxel to improve the look of the scars and then follow with a filler to smooth them out completely. 

I think I will likely try the laser first to see if it helps since it is the least invasive treatment and then maybe move onto the excision if the laser treatment doesn't work well. Good luck!

I know how it feels to have old chicken pox scars, and I have been looking into treatment for a few I have myself. I got the chicken pox when I was only two, and I must have done a lot of scratching of them on my face, because that is the only place I have scarring. 

While I haven't decided how I will get mine treated yet, I have read surprisingly good things about scar excision, although I know it sounds strange. To perform it, a cosmetic surgeon basically cuts the chicken pox scar out and then sutures the skin together around it which creates a flatter, much less noticeable scar. 

The best treatment for your chicken pox scars will depend on the size and shape of the scars. Laser therapy is sometimes a good option because it won’t create new scars and it’s also non-invasive. It may not completely get rid of the chickenpox scars, though, but it will make them less noticeable. Some people find laser therapy painful, which may be a good reason to go with a peel or another treatment instead.

With a peel, or a chemical peel, the top layer of your skin is taken off, which can get rid of chickenpox scars or at least make them less noticeable. There are all types of chemical peels for a variety of needs, so you’ll want to talk to your dermatologist about which chemical is right for you. Keep in mind that chemical peels can take a while to heal - up to two weeks - and they can sometimes sting. Other than that, though, the treatment isn’t very painful. You also may have some redness while your skin is healing.

Oh, better not to get pox, because even the mild case of chickenpox can be very dangerous, you can see how it looks https://illnessee.com/mild-case-of-chickenpox-pictures/. And these scars, ow, it is so horrible. Be more careful.

Can we see a photo? It depends on the depth of your scars. If the scars are very deep, you may require a combination of treatments. Subcision followed by fillers and/ or laser resurfacing should greatly improve your scars. I have had success using derma-rolling (microneedling) but my scars are not deep at all. I also get a medium-depth peel once every few months.