Acne & Scar Treatments
The intention is to eliminate age spots, blemishes, fine lines and minimize acne scars.
Facial scars or acne are very unsightly and can cause major embarrassment and distress, especially scars that are difficult to cover with make up. Our scar removal patients come to us with a range of scars to undergo effective treatments that can minimize the visibility of scars. We also routinely treat acne patients who have been left with scar tissue.
Superficial Acne Scar
Acne occurs when excess sebum (oil) is produced by the skin or from bacteria growth which can affect people of all ages. Acne can appear anywhere on the body but is commonly found on the face, back, chest, and shoulders. Acne is a long lasting problem that generally occurs during puberty; many suffer both emotionally and physically, especially when there is long-term scarring of the skin. Our experienced dermatologists specialize in both non-surgical and surgical acne scarring treatments to help diminish the appearance of acne scars.
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Types of Acne Scars:
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Atrophic shallow areas with irregular borders.
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Boxcar shallow depressions with broad bases, producing rolling scars which have very poorly defined borders.
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Ice pick-shaped, deep, narrow pitted appearance; sometimes looks similar to dilated pores.
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Skin Resurfacing: Pulsed light sources and radio frequency energy may be used in combination with surgical techniques to help minimize scarring and create new, smooth skin.
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Needling: A procedure that uses multiple needle injections to break up acne scars and stimulate new collagen formation, producing reorganization of the scarred collagen. For treating the face, the use of the Dermapen is showing good progress in softening the scars of acne.
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Laser skin resurfacing: Through short bursts of high energy, fractionated lasers can treat targeted areas of the skin to promote collagen production. Following several laser treatments, atrophic post-acne scarring shows improved texture and appearance.
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Chemical peels: Used for patients with atrophic acne scarring to remove superficial skin layers and promote collagen production. Peel strength can be customized for the patient’s needs to also treat deeper layers of the skin.
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Microdermabrasion: A non-invasive treatment that uses crystals and a vacuum to remove dead skin cells. This treatment may be used in combination with other acne scarring treatments or for the most superficial, shallow acne scars. Unless vigorously performed, microdermabrasion will only produce minimal results.
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Dermabrasion: A former acne scarring technique that uses a fast rotating wire brush to remove the top layer of skin. Now due to many problems with pigment, this technique is not used often.
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Hand sanding: A newer form of dermabrasion that is recommended for some patients. This technique uses no electrical instruments, nor any freezing sprays decreasing the risk of pigment loss or a permanent change in pigmentation as previous dermabrasion techniques. This is also safe for patients of color; patients with different levels of pigment in their skin. While not only effective, this hand sanding technique is safe and can be repeated even for patients with the worst acne and the darkest skin.
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Non-Surgical Options
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Soft tissue fillers may be used for treatment of atrophic scars to fill pitted or depressed areas on the skin. The results are temporary and additional treatments are necessary; silicone has been suggested by some but in general is not used by most. A very promising filler is the use of the patients’ own blood product (Platelet Rich Plasma) and fat cells.
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Alloderm and fascia lata are commonly used products taken from another person, processed, then transferred safely to another person. This is used as a dermal filler after subcisions have created a pocket beneath the sunken scar. The subcisions break up the scar which is hard and fibrous and pulling downward. The fillers serve as a scaffold onto which stem cells grow into new collagen bundles to fill sunken areas and provide a smoother surface. Benefits of these long-term fillers include minimal reaction or infection risk as they become a permanent part of the skin.
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Injections such as Cortisone or 5-Flurouracil can be injected into thickened scars which help flatten them and make them less itchy and red. For the redness, the Candela pulsed dye laser is frequently used and more recently BOTOX® has been injected into stubborn scars which helps soften them. For thickened scars, DOT laser is used first before the application of chemicals to help soften the scars.
Surgical Options
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Punch grafting/floating: Small skin grafts are used to replace acne scarred skin. Sometimes used to treat deep, ice pick scarring, punch grafting provides the most optimal results in less mobile areas of the face such as the forehead. Punch floating is the treatment of choice for most ice pick scars and usually heals in several months without a trace of the circular incision used to make the punch.
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Subcisions: A minor surgical procedure used for treating depressed acne scars. Using a micro blade or small needle to make small incisions that cut and separate fibrous bands and release the bound down scar, subcisions encourage wound healing for a smoother surface. This procedure is often combined with other treatments such as laser resurfacing for maximum effectiveness.
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Fat transfer: A process that transplants fat from one part of the body to fill acne scar depressions. This procedure eliminates risk of rejection or immune reaction as it uses your own fat. It is rarely used alone and most often has PRP (Platelet Rich Plasma) added to it. Sometimes the clot used to obtain the cytokines from the blood is used as a scaffold for new collagen to infiltrate. Occasionally the body’s own stem cells are also called to the injured area by the PRP.
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Acne scar excision: A scar removal technique that cuts out individual scars. Excision is rarely a recommended technique for patients with ice pick or deep boxcar scars; sometimes it is the only treatment for very deep irregular shaped scars in difficult locations.
