Advanced Acne Revision & Dermal Architecture

Specialized Clinical Protocols for Persistent Acne and Atrophic Scarring

Beyond Surface Treatment: A Structural Approach to Skin Health

At Mirelle Institute, we categorize acne and scarring as complex biological disruptions of the dermal matrix. Led by Dr. Corina Ianculovici, DNP, our protocols move beyond traditional aesthetics into regenerative medicine. We utilize a multi-modal "Search and Replace" strategy: arresting active inflammatory cascades while performing precision architectural revision of fibrotic scar tissue.

The Three Phases of Dermal Restoration

How this applies to Acne Scars

During these phases, the Matrix Remodeling (part of Phase 2 and 3) is most critical. By micro-injecting Hyaluronic Acid and Micro-Botox directly into the dermis, AquaGold ensures that the "new" skin growing in is more hydrated and has smaller pores than the "old" skin it replaced.

Phase 1: Out with the Old (Reaction Phase)

This is the initial correction and stimulation stage, typically lasting the first 1–6 weeks of a treatment plan.

What’s happening: The treatment (AquaGold, peels, or medical-grade topicals) accelerates cell turnover to shed the damaged, rough outer layer of the skin.
What to expect: You may experience "purging," redness, dryness, or light peeling. Acne can sometimes look slightly worse during this time as impurities are pushed to the surface. This is a sign that the "restoration" has successfully begun.

Phase 2: In with the New (Tolerance Phase)

As your skin adjusts to the specialized "cocktails" and micro-channeling, it enters the repair stage.

What’s happening: Your skin builds a tolerance to the active ingredients. The micro-injuries from the AquaGold needles trigger a surge in collagen and elastin production, which fills in atrophic scars and tightens pores.
What to expect: Irritation and redness subside. You will notice a visible improvement in skin texture and tone; the skin begins to feel firmer and more naturally hydrated.

Phase 3: The Healthy Glow (Corrected Phase)

This is the final stage where the skin has fully renewed itself.

What’s happening: Cellular regeneration has peaked. The skin barrier is now healthy, functioning optimally, and the dermal layer is structurally "restored."
What to expect: This is the signature "AquaGold Glow." The skin appears translucent, smooth, and clear. Maintenance becomes the primary focus here to keep the results long-lasting.

Aqua Gold Fine Touch Microneedling Facial at Mirelle Anti-Aging in Wall, NJ

In the clinical protocol at the Mirelle Institute, the treatment of acne with AquaGold® is not a single action but a combination of four distinct modalities that work in synergy to restore the dermis.

1. Micro-Channeling (The Delivery Modality)

Unlike traditional microneedling, which uses "rolling" or "pens" to create mechanical trauma, AquaGold uses a patented micro-channeling device.

Mechanism: 20 to 24-karat gold-plated needles (thinner than a human hair) are stamped into the skin.
Function: These needles create precise, vertical channels that bypass the protective epidermal barrier. This "direct-to-dermis" delivery ensures that 100% of the active ingredients reach the depth where acne begins and scars form.

2. Mesotherapy (The Infusion Modality)

While the needles create the path, Mesotherapy is the process of infusing the "cocktail" into those paths. For acne, this includes:

Micro-neuromodulators: To "freeze" the overactive sebaceous (oil) glands and shrink pore diameter.
Hyaluronic Acid (HA): To provide deep hydration, which signals the skin to stop overproducing oil as a defense mechanism.
Antioxidants/Vitamins: To neutralize the oxidative stress that often triggers inflammatory breakouts.

3. Collagen Induction Therapy (The Structural Modality)

Even without the serums, the physical act of the needles entering the skin acts as a structural modality.

Mechanism: The micro-channels trigger a "miniaturized" wound-healing response.
Function: This stimulates fibroblasts to produce new collagen and elastin. Over the "Three Phases of Dermal Restoration," this new tissue fills in the "divots" left by atrophic acne scars, effectively resurfacing the skin from the inside out.

4. Supplementary Intralesional Therapy (The Acute Modality)

For patients currently in an inflammatory "flare," providers often use a supplementary acute modality alongside AquaGold:

Cortisone Injections: For active cystic acne, a diluted corticosteroid is injected directly into the lesion.
Function: This provides immediate relief by collapsing the cyst and preventing the deep-tissue destruction that leads to permanent scarring.

At the Mirelle Institute, the acne revision strategy extends beyond AquaGold® into high-energy energy-based devices. These treatments are used to target deeper structural damage and the pigmentary changes (PIH) that often follow inflammatory acne.

1. LaseMD Ultra (Nano-Laser Peeling)

This is a non-ablative fractional thulium laser designed for precision resurfacing with minimal downtime.

Nano-Laser Peeling: It creates microscopic "bins" in the skin to gently peel away the damaged epidermal layer, smoothing out the very top layer of the skin.
Inflammation Control: The thermal energy helps to calm active inflammatory cascades, making it a powerful tool for those transitioning out of an active breakout phase.
Hyperpigmentation (PIH): It is specifically effective at breaking up melanin deposits, helping to clear the dark or red "ghost" marks left behind by old acne.

2. Genius® RF Microneedling

For patients with deeper, fibrotic acne scars (such as boxcar or rolling scars), the protocol shifts to Genius® RF Microneedling

Mechanism: Unlike AquaGold, which stays superficial, Genius uses high-intensity Radiofrequency (RF) energy delivered through insulated needles directly into the deep dermis.
Deep Structural Revision: The RF energy creates "coagulation zones," which trigger a massive remodeling of the skin’s architecture. This is designed to lift deep depressions and smooth out the "pitting" of severe scarring.
Precision Intelligence: The system provides real-time feedback to the provider, ensuring the energy is delivered at the exact depth needed for your specific scar tissue.

To complete the comprehensive acne revision protocol at the Mirelle Institute, we incorporate specialized mechanical and biological treatments to address the most stubborn scar tissue and accelerate healing.

1. Scar Subcision (The Mechanical Release)

For "tethered" or "rolling" scars that appear as deep depressions, Scar Subcision is the essential corrective step.

The Problem: Deep scars are often held down by thick, fibrous bands of collagen that pull the skin surface inward.
The Solution: A specialized needle is inserted under the scar to physically "break" or release these tethering bands.
The Result: Once the tension is released, the skin surface "pops" back up. This creates a flat plane that allows the other modalities (like Genius RF or AquaGold) to work on a level surface for smoother results.

2. Vampire Facial® / PRP (The Biological Accelerator)

Platelet-Rich Plasma (PRP) serves as the "liquid gold" of the restoration process, often paired with microneedling to supercharge the skin's natural repair mechanisms.

Mechanism: A small sample of your blood is processed to concentrate the growth factors and platelets.
Biological Action: When applied during a Vampire Facial, these growth factors signal the skin to rapidly produce new, healthy cells and high-quality collagen.
Clinical Benefit: It significantly reduces downtime from more aggressive treatments and is particularly effective at improving the texture and tone of skin that has been thinned or damaged by years of chronic acne.

The Integrated Acne Revision Strategy

The Mirelle Institute uses a "Search and Replace" strategy to provide a total skin solution:

Release: Scar Subcision breaks deep tethered bands.
Rebuild: Genius® RF creates deep structural volume in "pitted" areas.
Refine: LaseMD Ultra erases surface hyperpigmentation and redness.
Revitalize: AquaGold®Fine Touch and Growth Factors to infuse the skin with the nutrients and growth factors needed for that final "Healthy Glow."