Three years later, ready for more
The patient in this video came to Dr. Emer close to three years ago for acne scars and got significant improvement. Over time, some of the scars started to show again. This visit is a larger treatment: Bellafill filler placed earlier in the day to raise the deepest scars, followed by ProFractional laser and TRL ablation to resurface the skin and tighten the texture.
He has ethnic skin, which means the risk of hyperpigmentation is real. Dr. Emer addresses that risk with a peel before the laser and a strict post-treatment plan that includes high spot cream, peels, and cooling treatments like Glacial.
Why Bellafill takes more volume than you expect
Bellafill comes in 0.8 cc syringes, but only about 20 percent of that is PMMA microspheres. The rest is lidocaine and collagen. So you need a lot more Bellafill than you would other fillers to fill the same depth of scar.
Bellafill is also made for deeper injection, not surface placement. That is why Dr. Emer often combines it with micro droplet silicone or uses it in hyperdilution. In this case, he used Bellafill alone and then layered the laser treatment on top.
Two laser settings, one session
Dr. Emer started with ProFractional laser at a standard setting across the face, then switched to a slower, more intense setting over the deeper scars. When the laser goes slower, the heat stays in the tissue longer, which means more remodeling and more tightening in that specific area.
He also treated a thick white scar on the forehead with the more intense setting. That scar will eventually be cut out, but treating around it first softens the tissue and causes the skin to contract inward as it heals, which makes the excision easier and the final result cleaner.
Botox before the laser, and why
Dr. Emer injected Botox into the forehead before the laser treatment. When the forehead does not move during healing, scars in that area look less visible. If he had used filler or micro droplet silicone in the forehead, the same rule applies: you do not want the area to move while the material is settling, so you Botox it first.
Botox is a brand name. Other neurotoxins like Dysport and Xeomin work the same way. If one did not work for you, another might.
Healing on ethnic skin: the pre and post plan
Even lighter Hispanic or Mediterranean skin tones are at risk for hyperpigmentation after aggressive laser work. The plan to prevent that starts before the laser with a peel, and continues after with high spot cream twice a day, the Enlighten peel, aggressive hydroquinone, vitamin C, and cooling treatments.
High spot cream is a non-hydroquinone, non-chemical lightener made with botanicals, retinol, and vitamin C. Healing time is about five days, with pinkness lasting another week. Glacial cooling, oxygen, red light therapy, and peptide IVs all help reduce redness and speed recovery.
Who this fits
This treatment is for patients with acne scars who are willing to follow a strict pre and post plan, especially if they have darker skin. It is also for patients who have had one round of treatment and want to go deeper, or who have a mix of shallow and deep scars that need both filler and resurfacing.
Candidacy comes down to skin type, scar depth, and whether you can commit to the healing protocol, which is exactly what a consultation covers.