Presently available medical techniques for acne scar removal fall into 3 general categories:
1. Scar removal and revision
2. Filling in depressed scars
3. Contouring the surface of scars
The most common of these procedures, are:
Dermabrasion
Is a common cosmetic medical procedure where a dermatologist or cosmetic surgeon uses an electrical device to remove the surface of the epidermis of the skin (the stratum corneum). Dead skin cells are removed by abrasion (sanding), resulting in the skin looking smooth and fresh.
In addition to its use for acne scar removal it can also be used to remove dark spots on the skin as well as to treat skin that has been damaged from sun exposure. Patients often experience pain with this procedure and often require a general or topical anaesthetic.
The skin is usually very red and raw-looking after the procedure, it normally takes several months for the surface tissue to regrow and heal completely. Dermabrasion is considered most useful for scar removal where the scar has risen above the surrounding skin surface, and less effective on sunken or deeply pitted scars.
When first developed, the dermabrasion procedure made use of a small, electric dremel-like sander. Recently, CO2 (carbon dioxide) or Erbium:YAG lasers have become more common replacements with fewer risks. This newer type is referred to as Laser Dermabrasion and is much easier to control and gauge, and is practically bloodless compared to older styles.
Recovery time after laser dermabrasion is usually minimal and there is most often no need to take extended time off of work. This technique is not for everyone as its results are highly dependent on the characteristics of the patient’s skin.
Ideal candidates for laser dermabrasion are considered those who have healthy and fair non-oily skin. The results on patients with darker olive, black or brown skin may be higher pigmentation. In these cases it is important to consult with your physician or qualified technician prior to beginning any treatment.
Microdermabrasion
This technique removes the outermost layer of dead skin layer in order to fade more superficial facial scarring. A vacuum system is used to deliver aluminum oxide crystals through a tube and handpiece. The technician can determine the depth and rate of abrasion at which crystals are applied to the skin’s surface.
On average, patients require 4 to 8 treatments spaced 2 to 3 weeks apart. The method involves very little recovery time and is said to be a ‘lunchtime’ treatment. Moderated to severe acne is not known to respond well to microdermabrasion.
Collagen Injection
Purified bovine (cow) collagen can be used to fill in, and therefore raise, sunken scars to the same level as the surrounding skin. Collagen injections do not produce permanent results. Because they are made of natural protein, collagen will break down over time into amino acids and be absorbed by your body. In many cases, the effects of the injection will last anywhere between 3-6 months, although in some patients the effects of a single injection may last up to 2 years. There is also a risk of allergic reaction for these products with some patients.
This method is suitable for patients with a few acne scars with shallow shoulders (edges). Collagen is not considered suitable for narrow ‘ice-pick’ scars. It is a less expensive option, usually a .5 cc costs about $125.
Popular skin-filler products for this procedure are Resylane and Cosmoderm.
Steroid injections
A long-term course of steroid injections into scars may help to improve the appearance (by flattening and softening) of keloid or hypertrophic scars.
hypertrophic scars – are defined as raised fibrous lesions that do not extend beyond the edges of an initial injury and may demonstrate partial resolution on their own. They are common after thermal (heat-related) injuries and other injuries to the deep dermis.
keloid scars – raised and ill defined growth of skin in the area on and around the damaged skin. Keloids result from an overgrowth of dense fibrous tissue that usually occurs after the healing of a soft tissue injury. The scar tissue usually grows beyond the borders of the original wound, does not normally regress on its own and tends to re-occur after excision. Keloid scars are the more serious type, since they can continue to grow indefinitely into larger, tumorous (although benign) growths.
The steroid is injected into the scar itself; since very little is absorbed into the blood stream, side effects of this treatment are minor. However, this sort of steroid treatment can cause thinning of the skin. The procedure is often repeated at 4-6 week intervals.
Laser treatment
This procedure uses laser technology to ‘burn away’ the surface of damaged skin. A single session of this treatment may be enough to get permanent results. Laser ablative surgery for scaring is now considered the gold standard in which the entire epidermis is removed by light and permitted to re-grow. Vascular lasers that target small blood vessels in the skin tissue can greatly reduce the redness of most scars 6–10 weeks after initial treatment. To date, they haven’t been proven effective in flattening scars, although it has been theorized that removing layers of skin with a CO2 or erbium laser may help with this problem.
Surgery
Some acne scars (ie ice picks) can be removed surgically and the wound sewn up, this process is called scar revision. A small graft (often taken from the back of the ear) can be used to repair the hole left in the skin after it is excised to the level of subcutaneous fat. This technique can result in the new wound regrowing a hypertrophic scar.
Autologous Fat Transfer
Using this technique, fat is transferred from another part of the body to the scar site. This fat is injected under the scarred area in order to lift the depressed scar. This technique is often used to treat deeply contoured skin defects caused by nodulocystic acne. Because the transferred fat may be reabsorbed into your skin tissue you may require additional treatment sessions – often after 6 to 18 months.
Punch Grafts
Using this procedure the acne scar is punched out to remove the scar, which is then replaced with unscarred skin (often from behind the earlobe). Punch grafts are often used to treat deep acne scars.
Chemical Peel
There are three categories of chemical peels used as acne treatments, the chemicals used are:
- Alphahydroxy acid (AHA) or glycolic acid
- Trichloroacetic acid (TCA)
- Phenol
AHA peels are the mildest; TCA peels are considered mid-strength; and Phenol peels are known as the strongest of the three types. Each type of peel has advantages and disadvantages.
Alphahydroxy, betahydroxy and glycolic acids do not require much recovery time. It is however, common for patients to experience some irritation, redness, dryness as well as possible flaking at the treatment site. These side effects will eventually subside.
TCA peels can penetrate deeper layers of skin tissue and the effects last longer than the milder treatments, although recovery time is usually longer. These peels can cause swelling, crusting and an increased sensitivity to sunlight.
Swelling and any pain are usually gone within one week and by 10 days the patient is usually able to return to their normal routine.
However, redness produced by a TCA peel may last up to three months and the newly formed skin layers must be protected with a high-SPF sunscreen to prevent hyperpigmentation and blotching. Although phenol is a stronger peel than TCA, TCA peels can still produce unintended changes to skin color.
Phenol peels can cause the affected area to become very swollen, sometimes to the point where the patient’s eyes are temporarily swollen shut. As a result, up to two weeks of at-home recovery are often required after a phenol peel.
Excessively strong chemical peels run the risk of de-pigmentation and scarring. After a phenol peel, new skin will begin to form after about a week. The treated area, which will be very red initially, will gradually fade over a period of weeks or months to its normal color. The results of a phenol treatment can last for many years.
The best candidates for chemical peel treatments are patients with superficial acne or acne scars. Individuals with very active or severe acne are usually not good candidates for chemical peels. Women who are pregnant or breastfeeding should not use this method to treat acne.
Fraxel
Uses a fractionated laser that removes smaller areas of tissue in a consistent and rapid pattern. The results are often not as good as the laser ablative technique but it often leads to less down time and is generally considered a safer technique.
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