Dr. Weiner has been recognized on Acne.org as one of the top 1% of physicians in the U.S. who treats acne scars. His expertise with RF microneedling, particularly with the Infini and now the Genius, results in safer treatments for darker skin types with acne scars. Commonly, Dr. Weiner chooses multiple modalities and several treatments for his patients for optimal results.
Radiofrequency Microneedling (Genius)
Dr. Weiner is an authority and the largest user of radiofrequency microneedling (RFM) in the country. He has performed several clinical and FDA trials with the Infini and Genius. He has written 4 clinical papers and recently authored the definitive chapter on RFM in “The Facial Plastics Clinics of North America,” which cited 58 references. He has lectured throughout the U.S. and internationally on the topic.
The Genius uses coated (insulated) microneedles to deliver RF energy into the dermis resulting in zones of coagulation. The body heals the treated areas by creating collagen, elastin, and hyaluronic acid leading to remolding of the acne scars. The insulated needles protect the upper layers of the skin from heating, so darker skin is at less risk from the side effect of post inflammatory hyperpigmentation (PIH). RFM is able to treat all the types of acne scars: rolling, ice pick, boxcar, and hypertrophic. Most patients will have the Genius as part of their treatment regime.
The procedure will take about 15-20 minutes. Most patients tolerate the procedure with just numbing creams but we also offer Frozen C (cryotherapy) and Pronox (laughing gas) for further comfort measures.
Subcision is a manual method used to break up tethered scars. The most recent literature suggests that cannula subcision has less risk, less downtime, and higher patient satisfaction than tradition sharp subcision. Cannula subcision is the preferred method of Dr. Weiner. If a patient is to undergo Genius and has tethered scarring, it is highly recommended to have subcision to prevent extension of the RF heat from extending along the scarring into the deeper skin layers or subcutaneous fat. While it might appear in the videos that subcision is painful, the procedure is described by patients as much better than expected. Placement of lidocaine during the subcision process is routinely performed for patient comfort.
TCA is trichloroacetic acid and is a substance used for aggressive chemical peels. CROSS is an acronym for Chemical Reconstruction of Skin Scars. In acne scars, a very small amount of high concentration TCA is placed on a tooth pick and placed in the depths of icepick and small boxcar scars. This caused a small injury in the scar which is then healed from bottom up with new collagen to result in a shallower scar. In wider scars, a method called TCA paint can be used with less concentrated TCA. There are a few days of crusts that need to be kept moist to assure best results. A series of 4-6 treatments is usually needed.
In some patients, there are atrophic scars and areas of lipoatrophy (fat loss). The most efficacious method to treat these scars are with dermal fillers. The superficial atrophic scars require filler using a needle to place the product in the dermis. The two fillers used by Dr. Weiner in the dermis are Restylane Refyne and Bellafill. Deeper injections are required for fat atrophy from scarring as well as aging. These injections are performed using cannula technique and fillers used are Lyft, Restylane, Defyne, Sculptra, and Bellafill.
Resurfacing lasers are classified at either being non-ablative or ablative. Non-ablative lasers cause coagulation of the epidermis and dermis. Ablative lasers with lead to vaporization of tissue (removal of tissue) as well as varying degrees of coagulation. Typically, non-ablative lasers are less aggressive with less downtime and risk than ablative lasers. Darker skin types have high risks for PIH when ablative lasers are used with non-ablative lasers being safer. In general, Dr. Weiner prefers using RFM for scarring over lasers because of safety of RFM in all skin types and the improved downtime.
Lasers are frequently used for patients with active acne. Dr. Weiner uses 3 lasers for acne: Aerolase, Excel V+, and Spectra Gold Toning laser.
Fractional Pico Plus laser has been reported to possibly have benefits in acne scar improvements and is a treatment option for mild cases of acne scars.
Microneedling uses extremely small needles which cause microscopic holes in the skin and scars. Since there is no heat transmitted though the needles (as with RFM), there is minimal discomfort and rapid recovery. Microneedling is appropriate for very minor acne scarring. A series of treatments is always needed. This is safe for all skin types.