How is Acne Scarring Treated?
There are numerous treatments available for acne scars which can improve and soften the appearance of scarring. Given the complexity of acne scars, a combination of treatments is required. The treatment approach will depend on four factors:
Scar type (boxcar, rolling, icepick, hypertrophic or keloid)
Time available for the procedure
Cost of the procedure
Various methods of treating acne scarring are provided by the Skin Specialist Centre:
Hyaluronic acid fillers are best suited for shallow, broad-based acne scars and have the advantage of immediate improvement and minimal downtime. Treatment is usually repeated at six monthly intervals.
Intralesional corticosteroids/Five Fluorouracil injections are best suited for thick, lumpy scars. Usually several injection treatments are needed and the treatment can be combined with vascular laser at the same time.
There are two main types of laser treatments – ablative and non-ablative. With ablative lasers there is removal of thin layers of skin, and with non-ablative lasers (non-wounding) there is stimulation of collagen growth and tightening of the underlying skin.
Ablative lasers are of two types – fractional or non-ablative and fully resurfacing. Fully ablative CO2 lasers are best used on lighter skin types, whereas fractional CO2/Erbium lasers have a much higher safety profile than fully ablative lasers and can be used on all skin types. The downside of ablative lasers is the longer recovery time which can be up to three weeks, with redness being the most common temporary side-effect. Fractional (non-ablative) lasers are of variable wavelengths and improve acne scarring, especially in atrophic and rolling scars. They are also associated with temporary redness but there is no breakage of the skin surface. They have the advantage of rapid recovery times and the ability to treat darker skin types, with a higher safety profile. Recovery time is between 5 – 10 days. Most individuals will benefit from a series of fractional treatments but five treatments are usually required.
This is a non-invasive method of scar remodelling and is best employed in early acne scars, atrophic scars, rolling scars and is ideal in treating darker skin types, having the benefit of minimal chance of post-inflammatory hyperpigmentation. The eMatrix system (e-Two Sublative) is a unique sublative treatment which delivers a fractionated bi-polar radiofrequency technology that is highly effective for improving acne scars. This treatment is safe and effective on all skin types. The radiofrequency energy delivers fractional bulk heat deep into the dermal layer, to induce a skin injury in the region of the electrode handpiece. The skin surface and the surrounding tissue are not damaged, resulting in an accelerated healing process while maximising collagen production. The sublative treatment impacts only 5% of the top layer of skin (the epidermis). Therefore most of the dermis (the deep layer of skin) is affected, giving each individual optimal results with a quicker healing response and minimal downtime.
TCA Cross (trichloroacetic acid chemical reconstruction of skin scars)
This method uses high strength trichloroacetic acid, with strengths varying between 50 – 100% and is ideal for icepick scars. Usually two to three treatments are required.
Surgical Methods of Scar Removal
Such procedures include punch excision, punch elevation and subcision, which are useful for deep icepick scars, as well as tethered scars. Usually such approaches are followed by laser resurfacing or radio-frequency.
Subcision is an excellent treatment for rolling or boxcar-type acne scars, which often have fibrous attachments holding the base of the scar down to the underlying deeper tissue. After the surrounding skin is anaesthetised, a small needle is carefully inserted under the skin to sever and release these attachments beneath the scar. During the healing process, collagen remodelling occurs and new collagen is laid down beneath the scar, further improving the smoothness of the skin. Occasionally a filler substance (hyaluronic acid) can also be injected under the scars after subcision, to make the scar look less visible and to produce further enhancement.
Acne Scarring Outcome Following Treatment
The specialist dermatologist’s approach to treating acne scars is improvement rather than cure, with the degree of improvement being dependent on the combination of scar types and skin colour. Each person’s acne scars are a challenge for the specialist dermatologic surgeon and requires a tailor-made approach to the individual’s goals, tolerances, scar type and skin type, along with the specialist’s offering of a wide range of treatments as stated above. Understand that the deeper more extensive scars will take several treatments and patience while the skin heals. Superficial scarring will require patience as well. Management of darker skin types acne scarring can be difficult as the key problem is the avoidance of darkening of the skin (post-inflammatory hyperpigmentation). With the combination particularly of non-ablative laser procedures, radio-frequency devices and post-procedure fading creams and photo-protection acceptable results are usually achieved.
What’s the next step?
If you already have an appointment booked at The Skin Specialist Centre, you can easily add an acne scarring treatment consultation to your booking by calling our friendly team on (09) 524 5011. If you have never been to The Skin Specialist Centre, you can either give us a call on (09) 524 5011 or make an enquiry by clicking on the Enquire Now option below.