Acne Scarring

Quick facts

• There are various types of acne scars, each treated with different methods
• Skin needling, laser skin resurfacing, non-ablative laser treatments, Fraxel, fractional carbon dioxide laser, subcision, chemical peels, microdermabrasion, dermal fillers, and TCA cross are all methods of treating acne scars.
• As a rule, the more invasive the treatment, the longer the recovery period and the better the results

What types of acne scars are there-

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?

Fractional carbon dioxide lasers have been an even more recent development that can provide superior results to Fraxel treatments, but have a longer recovery period than Fraxel. Fractional carbon dioxide lasers are ablative lasers, that is, they vapourise columns of skin as well as heat the skin. By ablating as well as heating the tissues, more collagen stimulation and new skin formation occurs and it is possible to achieve superior results to non-ablative lasers. At The Victorian Cosmetic Institute we use the Lumenis Ultrapulse fractional carbon dioxide laser with the Active Fx and Deep Fx hand piece for the treatment of acne scars. The Active Fx targets the superficial skin, whilst the Deep Fx targets deeper skin.  The recovery period from fractional carbon dioxide laser treatment ranges from 3 to 10 days depending on the intensity of the treatment.

Skin needling is an older but very effective method of treating superficial acne scars by puncturing the skin with multiple fine 3mm (long) needles attached to a small rolling pin. This stimulates collagen production and helps to lift up any 'indented' scars. The advantage of this treatment 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 less risk pigmentation changes in comparison to laser treatments post-needling. 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. 

The Rhytec Portrait Plasma Skin Regeneration (PSR) machine is another method of resurfacing acne scars. This uses plasma energy to induce new collagen formation in the skin and regenerate skin. The total downtime is approximately 10 to 14 days for a high-energy treatment. We have found the results from this treatment to be reasonably effective, but not better than other treatments such as the Fraxel laser, skin needling, or the carbon dioxide laser.

TCA CROSS is a simple yet effective method of improving acne scarring. It is most commonly used for small indented acne scars. It involves careful placement of high concentrations of trichloroacetic acid into the scar with a toothpick. 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.

Subcision is another technique that is suitable for treating depressed acne scars. The size of the scar usually needs to be fairly large or deep. It involves putting a special needle under the depressed scar. Often acne scars are depressed because the skin is tethered to the underlying tissues. Subcision helps to help release it from the underlying structures. It is often combined with skin needling, TCA CROSS or other laser treatments.

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, however multiple treatments need to be performed. Usually, several treatments are required. There have been clinical studies showing the effect of this laser on flattening the topography of 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. 

TABLE: Comparison of various treatments for acne scarring

How can I treat severe/grade 4 acne scarring-

In most cases of severe scarring it is only possible to improve the scarring, but not to completely eradicate it.

Techniques such as skin needling,  and skin resurfacing, as mentioned above are effective in the treatment of severe acne scarring.

More specifically;

• Ice-pick scars are difficult to treat, and may require excision or skin grafting
  
• Divots and large scars can be treated with subcision (see description above) or excision/grafting
  
• Deeper scarring may also require filling with fat grafts or dermal fillers.
• Sometimes scars need to be excised, for example, ice pick scars.
  
• Significant keloid or raised pigmented scars may need to be treated with intralesional corticosteroid or cytotoxic injections (5-FU) to help reduce the bulk of the scar.
  

Why should I choose The Victorian Cosmetic Institute as my provider of acne scarring treatments-

There are many factors when deciding what treatment to use when treating acne scarring. Our doctors are highly experienced in the treatment of acne scarring, and will be able to help you decide which treatment best suits you and your skin condition/type.

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 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.