Treatment of Acne Scarring
Acne is a skin condition that affects most of us in our teens and twenties, and some of us as we get into our adulthood. Many of us luckily recover from acne without any permanent effects, but some people are left with disfiguring acne scars. There are skin care products and medications that can improve mild scarring, but most acne scars are treated with a combination of surgical procedures and skin resurfacing.
Early Acne Scars
After an acne lesion has healed, it can leave a dark or hyperpigmented mark on the skin. This is actually not a scar, but rather a post-inflammatory change. The hyperpigmentation is seen as the skin goes through its healing and remodeling process, which takes approximately 6-12 months. If no more acne lesions develop in that area, the skin can heal normally. Any color change or skin defect still present after 1 year is considered to be a permanent defect or scar.
Preventing Early Acne Scars
The best way to prevent post-inflammatory changes caused by acne is to prevent acne lesions from occurring. This is done by understanding the factors that cause acne and using the appropriate treatment for the different acne types.
Treating Early Acne Scars
- Wearing a good sunscreen is important to prevent damage to the skin and delays in healing of the post-inflammatory pigmentations.
- Using tretinoin (Retin-A, Renova) speeds up the skin’s remodeling process and helps heal post-inflammatory changes.
- Using Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) also help the skin’s remodeling process.
- Picking at scabs should be avoided. Scabs form to protect the healing process that is going on underneath them. Pulling a scab off before it is ready interferes with the healing and remodeling process, prolonging the time that post-inflammatory changes will be visible.
- There are numerous procedures that can be used to correct acne scars. Each procedure has its own risks and benefits.
There are many types of dermal fillers that can be eased into acne scars to raise the surface of the skin and give it a smoother look. Dr. Bolourian will discuss with you the most effective fillers for your particular skin type. Examples of dermal fillers that maybe used are fat, collagen and hyaluronic acid. The injection of these materials do not permanently correct acne scars, so further injections may be necessary.
This method of correcting acne scars is used on deep scars such as ice pick and deep boxcar scars. Dr. Bolourian uses a punch biopsy tool that comes in different diameters. The size of the tool is matched to the size of the scar to include the walls of the scar. Under local anesthesia the scar is excised with the punch tool and the skin edges are brought together with few simple stitches. The newly produced scar eventually fades and may not be noticeable. If it is noticeable, it will be more amenable to laser resurfacing and improve the remaining scar.
Dr. Bolourian may suggest combining several procedures and treatments to create the smoothest appearing skin.
Punch Excision with Skin Graft Replacement
With this method the scar is excised with the punch tool as described above. The defect is filled with a punch skin graft usually taken from behind the ear. With this procedure a color and texture difference may be noticeable, but a skin laser resurfacing technique can be used 4-6 weeks after the grafting to correct this color difference.
Subcutaneous incision, also known as Subcision, is used to break up the fibrous bands that cause rolling scars. Dr. Bolourian performs this procedure under local anesthesia. He inserts a specially beveled needle under the skin so that it is parallel to the skin surface and precisely breaks up the attached scars and stimulates new and healthy collagen production. This procedure causes bruising which fades after about 1 week.
Laser resurfacing is a popular treatment for acne scarring. Dr. Bolourian will evaluate your skin and will discuss your options to achieve maximum improvements. Post-operative care is an important factor in laser resurfacing for the treatment of acne scarring. Therefore close follow-ups are an essential part of the treatment.