Conditions - Acne Scar
Acne Scar Treatment
One of the most common concerns I have from patients, is the treatment of their acne scars.
Firstly, it is important to define what acne scars are. Many people may think that the red or brown mark left behind after acne is scarring, but it is not. It is what we call post inflammatory hyper pigmentation (PIH), and they tend to fade after weeks to months. Acne scars on the other hand, are the actual “pot marks” you can actually see and feel. It is usually depressed (like a crater), and very rarely may be raised. It stays with the patient for years and does not resolve on its own, unless treated. Acne scars are stubborn, persistent and notoriously difficult to treat. Even with the best technologies around, multiple treatments may be required to see appreciable differences.
Below are some commonly asked questions:
1. How are acne scars formed?
Acne scars are the depressed or pitted skin irregularities that form in the locations of previous acne. The inflammation that accompany acne results in the production of chemicals which depletes the skin of collagen, making it thinner around the area. Furthermore, with the healing which is often imperfect, normal connective tissue is replaced by tight fibrous bands of scar tissues. This causes the skin to be pulled down from the skin surface, and tattered to deeper structures such as the SMAS, resulting in the undulating surface which we observe.
2. How is PIH different from acne scars?
This is a common misunderstanding by most people that the red or brown marks left behind after an acne resolves is a scar. It is in fact a pigmentation problem which tends to self resolve with time. When there is inflammation in the skin, the cells which makes pigments (melanocytes) are activated and over produces pigments which it dumps onto the skin surface. This phenomenon will slowly resolve when the melanin production is regulated and the layer of affected skin is renewed.
Acne scars of the other hand, is the actual formation of scar tissues, with a change in the skin architecture, as described previously.
3. Can we treat PIH?
Yes! Timely and appropriate care is important in the prevention of skin disorders. Firstly, it is paramount that you get your active acne condition treated. There is little point in treating acne marks and scars when new ones are still being formed. Therefore, we will usually recommend that we treat your active acne, before discussing how to treat the marks and scars later. A range of treatments including topical treatments, oral and even procedural treatments can be done to get your acne under control.
There are also preventive measures one can ensure to reduce PIH even in the presence of active acne. For instance, avoiding excessive sun exposure, together with the regular use of high powered SPF will reduce the activity of melanocytes. The application of a Vitamin C products can help fade the patches quickly. Other lightening creams may also be helpful.
Procedures which encourage skin renewal can hasten the recovery of PIH. This includes microdermabrasion and chemical peels. This works by quickly removing the skin layer which has higher concentration of melanin deposited in them. To enhance the breakdown of pigments, acne laser treatments can help break down melanin to hasten the recovery.
4. Are there different types of acne scars?
Acne scars come in different shapes and sizes, and their treatment choice varies depending on (in part), their shape and type.
Acne scars are typically classified as rolling scars, box scars, ice picked scars or raised (hypertrophic scars).
5. What options are there for the treatment of acne scars?
In the treatment of acne scars, there is only one principle to be understood; the destruction of the tight, binding fibrous tissue (destroy), as well as the stimulation of new collagen production for skin renewal (build).
A) Chemical Peeling
Chemical peeling is useful in mild and shallow scars. How it works is by removing the top layer of the skin, and encouraging new skin formation from the bottom up. You would hope that with every new layer of skin formed, the skin would be smoother. This works well however, only for very mild and shallow scars. For deeper scars, most superficial and medium strength peels will not be sufficient. For our Asian skin types, we may also not tolerate deeper peels as we have a much higher risk of PIH (post inflammatory hyper pigmentation) from the chemical peeling.
TCA cross is however, very useful in the setting of ice picked scars. This procedure basically uses high concentrations of TCA (trichloroacetic acid) on a concentrated area to break underlying fibrous tissue.
Similar to chemical peeling, the removal of surface skin and trying to encourage growth of new skin from beneath is useful, but only for a handful of elected patients with mild and shallow acne scars.
C) Energy-based Resurfacing- Fractional Laser and Radio-Frequency
Fractional Energy based device (EBD) treatment is a non-invasive treatment that uses a device to deliver a laser or radio frequency beam, divided into thousands of microscopic treatment zones that target a fraction of the skin at a time. This is analogous to a photographic image being enhanced or altered pixel by pixel.
Fractional treatment works by targeting both the epidermis and dermis. It does this by delivering an energy beam that is divided into thousands of tiny but deep columns of treatment into the skin.
These are called microthermal treatment zones (MTZs). Within each MTZ old epidermal pigmented cells are expelled and penetration of collagen in the dermis causes a reaction that leads to collagen remodelling and new collagen formation. By using MTZs, the energy targets and treats intensively within the zone whilst surrounding healthy tissue remain intact and unaffected and helps heal the wound. This fractional treatment results in a faster healing process than if all tissue in the treatment area was exposed to the laser.
The benefit of using a radio frequency device over laser is also that it is “colour-blind”, which means it is suitable even for darker skin types, and has less chances of causing post-inflammatory hyper pigmentation.
You can read more about E-Matrix Fractional Radio-frequency here.
Subcision is a minor surgical procedure used for treating depressed cutaneous scars and wrinkles. It is also called subcutaneous incisional surgery. Subcision is performed using a special hypodermic needle inserted through a puncture in the skin surface. The sharp edge of the needle is used to break fibrotic strands that are tethering the scar to the underlying tissue. The release of the fibrotic strands and new collagen deposition caused by wound healing leads to cosmetic improvement of the scar. Subcision can be safely performed in the outpatient setting and is usually well tolerated.
E) EnerJet Acne Scars Removal
The EnerJet technology is a novel, revolutionary technology that utilises pneumatic energy to deliver micro droplets of skin enhancing solutions such as hyaluronic acid into the dermal layer of the skin. The solution enters the skin through a tiny hole and spreads laterally, generating an area of controlled injury. The body then respond to this injury by stimulating fibroblasts in the skin to produce more collagen and elastin. The result is improved skin thickening and properties, with a long term skin remodelling effect.
You can read more about EnerJet Acne Scar Treatments here.
6. Whats should take into consideration when I start acne scar treatments?
When seeking treatments for acne scars, it is often necessary to develop a treatment regimen that incorporates several modalities to optimise the appearance of acne scars. It is a balance between building (collagen) and destroying (scar tissue).
First, it is most important that you develop a skin care regimen that maintains the health of your skin, and reduces future breakouts. The underlying cause of acne scars- acne, needs to be treated. This may include topical and oral treatments.
Secondly, a series of treatments such as chemical peels or microdermabrasion can be done, which offers some correction. But later on, procedures which induces collagen stimulation (such as fractional lasers and fillers injections) can be undertaken. New innovative treatments such as Enerjet has shown a lot of promise. It combines both scar tissue destruction and collagen building in one treatment.
Interested to find out more?
Call us at +65 6235 4429 for an appointment now.
About VIDASKIN Clinic
VIDASKIN Clinic is a premier medical & aesthetic clinic in Ngee Ann City, Orchard, Singapore providing a comprehensive range of medically proven solutions.
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