Dealing With Acne Scars?

Scarring results from injury to the deep dermal layers of the skin. Acne scars most commonly occur as a result of intense inflammation such as rupture of the oil glands or ‘pores’. Inflammation of the dermis disrupts the evenly ordered structure of collagen. Collagen is the scaffolding of the skin that gives it strength, tone and flexibility.

To repair the damage done to the dermis, one must remodel old collagen and reform new collagen-this is the basis of scar revision.

This concept is important to understand – scars lie deep in the skin. Treatments such as superficial peels and MICRODERMABRASION do not penetrate deep enough for any permanent results.

Rolling scars

These scars appear as rolling undulations in the skin and occur as the result of tethering of otherwise normal appearing skin. A number of methods can be used to treat rolling scars including subscision, fractionated laser resurfacing and Dermapen skin needling. These scars can be challenging to treat and often a number of methods and sessions must be used to achieve the best possible result.

Ice pick scars

Icepick scars, as the name suggest are sharp and narrow scars that extend deep into the lower layer of the dermis. These scars are too deep to correct with laser. Procedures such as punch excision or TCA cross can dramatically improve the scar.

Though laser has minimal impact on ice pick scars, fractionated laser/fraxel is often used to treat surrounding scars. Most commonly patients will present with a variety of scars, and these will all need to be treated in a specific way. Once the level of ice pick scars are raised and scars are shallower, resurfacing laser can then finish off the job.

Box car scars

These are depressed scars which have sharp edges that do not taper to a point (unlike ice pick scars) . These scars can be round, oval or linear and often occur around the temples and cheeks. Shallow boxcar scars can be treated with laser resurfacing, TCA cross or dermal grafting.

Macular scars

This form of scarring is characterized by flat areas of increased pigmentation. In most patients the areas appear redder then the surrounding skin. Patients with darker skin types will notice darkening of macular scars. The vast majority of macular scars will fade within 3-8 months. Patience, sunscreen and prevention of new lesions are key points of treatment. For macular scars that are persistently red, laser treatments with V beam can be of benefit.

Hypertrophic and keloid scars

This type of scarring occurs when the body sometimes produces too much collagen, this in turn creates a haphazard array of collagen fibers. The aim of treatment is to slow down collagen production and to encourage ordered formation of new collagen in the dermis.  Corticosteroid injections and silicone gel gives a predictably excellent outcome. Fractionated laser can then be used once the scar flattens out. Vascular laser can reduce the redness.

Acne scarring is a specialist field in itself. Scars maybe present at different depths and types, and in different skin types. All cases of acne scarring are assessed individually and a treatment plan tailored to the clinical examination of the patient.

Laser treatment of acne scars

Our Specialist center has 12 lasers, each with a specific role. Patients with acne scars types are matched according to which laser is BEST for their scars. Early and mild scarring respond best to Fraxel 1927 or the Fraxel 1550 (ideal for scars), whilst severe scars respond best to a combination of CO2 plus Erbium laser. Early scars respond best to RadioFrequency with Ematrix, whilst scar in darker skin types respond best to Erbium Profractional laser. Red flat scars respond well to IPL and V Beam or 755 Alex laser.

Sounds confusing? It’s because Dermatology and Hair Restoration Specialists tailors a program based upon your scar type, skin type and downtime- no cook book programs at our center.

More information on laser resurfacing

High strength TCA peels

TCA Cross is a method used for treating isolated deep ice pick scars. Application of high strength Trichloroacetic acid encourages collagen formation, lifting deep scars. Several treatments are advised. Ice pick scars are notoriously difficult to treat, they do not respond to Fractionated laser resurfacing/ Fraxel treatments.

More information on TCA cross for acne scars

Skin needling/ Roll Kit / Derm Rollers / Dermapen

With the event of Fraxel and Fractionated laser systems, the use of skin needling has seen a steady decline over the past 2 years. Skin needling uses a medical grade roller to puncture minute columns in the skin, reaching deeper layers to stimulate collagen formation. Several treatments are needed. Skin needling is safe on all skin types including darker ethnic skin. Fraxel and ProFractional systems generally perform 30-60% BETTER than needling.  Recovery time is in the order of 3 to 7 days. Expect to see between 20% to 30% improvement with each session of skin needling or Dermapen. Do not be confused, skin needling is NOT laser fractional resurfacing. The controlled heat with lasers provides superior collagen remodeling than DERMAPEN treatments.

More information on skin needling, also known as microneedling

Subcision

This surgical technique is often combined with Fraxel / ProFractional laser systems to treat deep bound down scars. This technique breaks down collagen that puckers the scar downwards. The surrounding scar is injected with local anesthesia, and a needle is inserted to run parallel to the skin to deeper structures. Release of the bands that bind down the scar visibly lifts the scar, smoothing the skin’s appearance. Punch excision can also be used to treat deeper ice pick scars.

Chemical peels

AHA peels can be of benefit in cases of mild acne scarring. Glycolic acid peels can stimulate collagen early in the course of scar repair as well as improve skin texture.

Dermal fillers / dermal grafting

This method maybe effective in treating depressed scars. Fillers last 4-18months. Dermal grafts for acne scars last longer. We prefer to use dermal fillers rather than dermal grafts due to the 5-10% complication rates of dermal grafting.

More on Dermal Grafts and Fillers

Blue and red light treatments

These wavelengths of light have been effective in treating acne and acne scarring. Treatments are best conducted early in the process of scarring. Improvements can be expected in mild cases of acne scarring.  A series of treatments are advised. The wavelength of red light has been shown to stimulate collagen formation, and aid in wound recovery. We often combine LED treatments with Fraxel/ Fractionated laser resurfacing and chemical peels for added benefits. Blue light can temporarily treat acne, and is NOT recommended as a cure for acne.

More on Red Light therapy

Corticosteroid injections

This method is used to treat raised scars- hypertrophic or keloid scarring. These scars generally occur on the upper back, chest, shoulders and jawline areas and present as hard lumpy areas. Several courses of injections can flatten out these areas over time. The result is generally excellent. Fractional laser can also reduce the hardness of these scars, however 3-4 treatments are often needed.

The successful treatment of acne scarring is a major challenge to treating specialist. For the patient acne scarring can be traumatic and distressing. In the past scar treatments have had limited success however with the evolution of new laser technology, patients can expect to see significant improvements with little down time. Fraxel or fractionated laser resurfacing has revolutionized acne scar treatments.

It is important to realize that patients will often have a mixture of scars and choosing a specialist skilled in performing all procedures will give the best outcome.

Fracionated laser treatment (Fraxel , ProFractional ) produces hundreds of tiny but deep mico-columns of treatment into your areas of scarring. Each column is the diameter of your hair shaft. Laser ablates the scars and old collagen, but also leaves areas of your skin untouched, forming the basis of Fraxel/ fractional laser treatments. For every micro column the laser treats, it leaves the surrounding tissue unaffected and intact. This fractional treatment allows your skin to heal much quicker than if the entire surface was treated at once as the untreated area heals the wound by removing the treated skin and replacing it with new tissue.

The advantage of treating skin this way is that there is less downtime and side effects while obtaining a significant clinical improvement. This type of scar treatment is also safe in darker skin types such as in Asian skin.

With deeper scars, CO2 laser can be used during fractionated laser resurfacing. With this technique more collagen stimulation is achieved, however down time approaches 7-10 days. Your treating specialist will discuss a treatment plan to give you the best possible results, and balance your downtime.

More on Fraxel for acne scars

Dermatology and Hair Restoration Specialists has 7 Fractional devices. This gives us the flexibility to choose the BEST device for your acne scarring and not the other way around. Fractional methods of treating acne scars will result in quicker recovery, and added safety especially in darker skin types. Most often, Specialists combine several fractional devices within the ONE treatment. This provides far superior results than using only one method.

Fraxel 1927

• Best for: very early superficial acne scars, ideally for sundamage and pigment
• Downtime: 4-6 days
• Skin type: all skin colours and skin races can be safely treated

Fraxel 1550

• Best for: Medium depth box, rolling and mixed acne scars
• Downtime: 5-8 days
• Skin type: all skin colours safely treated

Profractional Erbium

• Best for: Medium to deep acne scars
• Downtime: 3-6 days
• Skin type: all races safely lasered

Profractional Erbium with CO2

• Best for: Medium to deep rolling and box car scars
• Downtime: 5-8 days
• Skin type: Fair skin types – type 4

CO2 Core Fractional

• Best for: DEEP rolling, mixed acne scars, severe scars
• Downtime: 5-9 days
• Skin type: Fair- type 4 skin types

RF Ematrix Fractional subablative

• Best for: Very early scars, patients on Roaccutane, compound remodelling
• Downtime: 0- 12 hours
• Skin type: all skin colours safely treated

Dermapen Skin Needling

• Best for: some scars, not nearly as good as laser as no controlled heat produced
• Downtime: 2-6 days
• Skin type: all skin colours treated safely

Red acne scars, also known as macular acne scars will often settle over a period of 6 -12 months. The use of Vascular laser such as V-Beam can reduce the redness over several sessions. Treatments are quick, painless, with little if any downtime. Bruising can be expected in 25% of patients, however this settles within 2 – 4 days  of treatment.

We recommend 2-3 sessions for best results.

More on Lasers for red acne scars

The first step in the management of acne scars is identifying the type or types of scars you have. This is the most important step, and hence an assessment by our Specialist Laser Dermatologists is essential.

Once acne scar types are identified, we can then plan a program based upon your scar type, skin type (skin colour) and downtime.

Our specialists can give you a realistic percentage improvement, as well as a time frame and costs associated with scar revision.

Trusting a physician to revise scars can be daunting form many patients as acne scars can be a complex mixture of scar types.  Assessing your type of scarring and medical history is the very first step in acne scar revision.

Laser trained and procedural dermatologist are best equipped with expertise and the latest technology to give optimal results to our patients. At Dermatology and Hair Restoration Specialists, all major laser and surgical treatments are performed by our highly qualified Dermatologists; so you can be sure that you are in experienced hands.

Less invasive fractional resurfacing or Dermapen Skin Fractional Needling are conducted by our highly trained laser nurses.

Call us directly on 310-315-4989 to make an appointment, or to discuss issues regarding the referral process.

Cost for Acne Scar Revision will depend on the number of treatments you will require and how complex these procedures are. Some patients may only need 2-4 treatments, whilst others may require more than 8-10 treatments.

Entry-level skin resurfacing by our team starts at $240 for Dermapen Skin fractional needling, and $95 for AHA peels.

Severe and complex cases of acne scarring are treated by Specialist Dermatologists, using a program consisting of surgery, peels, and several forms of laser therapy.

It is hard to give an accurate estimation without a through assessment. Costing for the program is reflective upon the complexity of the procedures. In many cases of complex scar revision, procedures are partially covered under Medicare.