Acne Scarring
What types of acne scars are there?
• Rolling scars - these acne scars appear as undulations in the skin and are usually caused by tethering of the skin to underlying structures
• Deep divots - these are simply very deep scars that involve loss of subcutaneous tissue volume and result in a large ëdivotÃ.
• Ice-pick scars - deep but small holes in the skin, similar to the indentation left by an ice-pick.
• Hypertrophic scarring - where there is a raised and often pigmented scar as a result of acne. Keloid scars are a severe form of this.
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What categories of severity of acne scars are there?
Acne scarring can be categorised as (Goodman & Barron);
• Grade 1 - macular scarring or flat scarring that is characterised by flat areas of increased or decreased pigmentation visible from greater than 50cm
• Grade 2 - mild disease that is visible at distances of less than 50cm and can be covered by make-up. Examples include mild rolling acne scars.
• Grade 3 - moderate disease that is visible at 50cm or greater and is not easily covered with make-up or the normal shadow of a shaved beard hair. Stretching the skin can flatten the scar. Examples include more significant rolling scars, shallow boxcar scars, and mild to moderate hypertrophic scars.
• Grade 4 - severe disease as in grade 3 but scarring is not flattened by stretching the skin. Examples include severe boxcar scars, deep divots, ice pick scars, and hypertrophic keloid scarring (very raised/pigmented scars).
How can I treat macular, grade 1 scarring?
How can I treat more superficial, grade 2/3 scarring?
More recently, the Rhytec Portrait Plasma Skin Regeneration (PSR) machine has been a more viable alternative to resurfacing acne scars without the side effects and prolonged downtime of carbon dioxide lasers. The total downtime is approximately 10 to 14 days for a high-energy treatment, and so far there have been no cases of scarring or loss of pigmentation internationally.
Skin needling is another effective method of treating superficial acne scars by puncturing the skin with multiple fine 3mm needles attached to a small rolling pin. This stimulates collagen production and helps to lift up any 'indented' scars. The advantage of this treatment over plasma skin regeneration is the fact that it can be used on all skin types including darker skin types. People of Asian, Indian, African, and European background are able to have this treatment with no risk of hyperpigmentation post-treatment. Also, it penetrates very deeply so that collagen can be stimulated on deeper acne scars. Skin needling generally requires several treatments, usually once a month. Usually it takes 3 to 7 days to recover from the treatment, depending on the degree of the treatment. Fraxel laser is another method similar to skin needling that uses a laser to create multiple pin-point injuries to the skin. However, the penetration depth is approximately only half of that of skin needling (1.4mm), and it is our opinion at The Victorian Cosmetic Institute, that skin needling is more effective in most cases.
Our Medlite q-switched Nd:YAG laser, which is used also for tattoo removal and pigmentation removal, can also be used at settings to help promote collagen production and help improve mild superficial acne scarring to help raise small indentations in the skin. The advantage of this treatment is that it has only a small amount of downtime in comparison to the above treatments. Usually, several treatments are required. There have been clinical studies showing the effect of this laser on flattening the topography of acne scarred skin, and a general overall improvement in skin texture and smoothness.
Chemical peels are another method of treating more superficial acne scarring. Generally, medium to deep chemical peels are required to achieve a significant result, but a series of more superficial chemical peels could help achieve some improvement in milder acne scarring without significant downtime.
Blood transfer is a unique method of injecting one's own blood into a depressed acne scar. For deeper scars, blood can be injected to correct the skin deficit, which then induces collagen production in the area to produce a medium to long-term improvment. For more superficial scars, a smaller amount of blood is injected superficially into the scar, and then a vascular laser such as the Gemini laser is used to fire into the acne scar containing blood. The laser is attracted specifically to the blood, and this induces a stimulation of collagen in the scar which helps to raise the skin to a more even level.
How can I treat severe/grade 4 acne scarring?
For ice-pick scars, there is a technique called TCA Cross. This involves careful placement of high concentrations of trichloroacetic acid into the ice-pick scar. This stimulates the production of new collagen and remodelling of existing collagen to fill in the acne scar. The advantage of this treatment is that it is localised to the problem only and not the unaffected skin.
Deeper scarring may require filling with fat grafts or dermal fillers such as Restylane, Perlane, Radiesse or Juvederm. Fat grafting will need to be performed by a plastic surgeon and tends to be more permanent. Significant keloid or raised pigmented scars may need to be treated with intralesional corticosteroid or cytotoxic injections to help reduce the bulk of the scar. The Medlite laser can also help with reducing the pigmentation of the keloid scar.
Overall, there are a number of treatments that are effective in the treatment of acne scarring. As a rule, the more invasive the procedures will yield better results with fewer treatments, but will require more recovery or downtime.
A consultation with one of our medical staff will help assist you in your decision about which treatment will best suit your goals and lifestyle. Due to the large number of treatments available, a consultation will help you decide which best treatment suits you. As a rule of thumb, the more invasive the treatment, the greater the downtime, and the greater the improvement.
The first step is simply contacting us for your initial skin consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your laser treatment.
Making that first phone call about any cosmetic procedure can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.
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