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Acne Scar Treatment

Acne Scar Treatment should start right from the acne eruption. A proper and adequately treated acne eruption is the most effective way of acne scar treatment. This is so because the scar is prevented from forming or it never has the chance to get started in scar formation.

Acne Scar Treatment

Acne Scar Treatment handle the complication of acne eruption and bursting of pustule that is not adequately treated.

Acne scar has always been difficult to treat. Over the course of history, newer method and technology, technique has evolved for better acne scar treatment result.

Given here, the acne scar treatment may be described with the followings. This includes laser treatment, punch excision and stitch, punch excision and punch graft, punch and elevation, subcutaneous incision, dermabrasion, micro-dermabrasion, chemical peels, filler treatment, and steroid jab.

 

Acne Scar Treatment

Acne Scar Treatment is Based on Acne Severity and Choice of Rx

 

Acne Scar Treatment: Laser treatment

Acne Scar Treatment can be effectively treated by laser mode.

Overall, the laser treatment may be divided into the more conservative laser called non-ablative laser treatment. The next group is more aggressive and more invasive is thus called ablative laser treatment. The non-ablative laser treatment has no to minimal downtime as compared to the second group, which can have a longer down time.

 

Non-Ablative laser treatment Ablative laser treatment
More conservative More aggressive
No to Minimally invasive More invasive
No to minimally breach of skin treated Usually breach of skin treated
No to minimal downtime, lunch time laser Downtime is unavoidable
Cheaper compared to ablative In general, cost more
Result may be slower Usually faster result
Nd YAG laser –for mild scar, rolling scar, Boxcar scar, and pigment scar

Pulsed dye laser—for hypertrophic scar, keloid

Eg carbon dioxide laser, fractional & non-fractional, minor to classical ablative

Erbian YAG laser

Both for rolling scar

Create changes in upper dermis layer Reach deep into full depth of dermis

After the laser treatment of acne scar, the skin looks refreshed, glowing and feels smoother in texture. The atrophic scar with depression get shallower due to collagen remodeling and deposition beneath the scar. The scar fades with smoother texture. There may have erythema, or redness which normally fades and disappears over couple of months.

Acne Scar Treatment: Punch excision, punch elevation, punch grafting

Acne Scar Treatment can be done by various surgical method as listed here.

We have all seen the cookie cutter of various shape. Circular is a common shape. Punch excision cutter operate on the same principle. It punch and excise away a small vertical cone of scar tissue with depression such as the ice picked scar and Boxcar scar. If the cone is small like the ice picked scar, we may leave the hole as such, which heal quickly over couple of days. However, it is even better if we can approximate the deficit by putting on a small suture.

For Boxcar scar, we can choose the punch of two different sizes such that the edge of the scar is excised, and we can lift the central portion of the scar to level with the surrounding skin by applying a stay suture. In this way, the color and texture is similar to the surrounding as compared to punch and graft, whereby the new donor graft is usually harvested from behind the ear.

In punch excision and grafting, this is used for scar whereby the cone of tissue excised is too wide. Without giving new tissue to cover up the deficit can create scar worse than before treatment. Therefore, clinician or aesthetic surgeon will put back another similar sized graft to plug the hole and put a stay suture.

Acne Scar Treatment: Subcision

Acne Scar Treatment by subsicion is the most popular.

This is a technique that employ a needle or a special mini scalpel that is inserted beneath the rolling scar, to sever the fibrous band that pull down the superficial dermis into deeper layer of dermis and subcutaneous structure. In so doing, the scar tissue is instantly released and the skin looks smoother. A filler may be injected beneath to help lift the scar and to let new collagen deposition to takes place to prevent it from sticking down back again.

Acne Scar Treatment: Dermabrasion

Acne Scar Treatment by dermabrasion is only effective if done until the dermis layer. However, the risk of scaring increases.

This treatment employs a rapidly rotating wire brush that abrade the skin surface. This needs to be done under local anesthetic. The depth of abrasion can be controlled, usually can reach up to reticular dermis, the deepest part of dermis beyond which scaring can occurs. The downtime can be long. Wound healing should complete in one to two weeks. The erythema or redness can last several months, but eventually will fade and completely disappear.

It must be noted that, Dermabrasion was formerly the Gold Standard in scar treatment but with the advent of laser, it has been discarded in favor of laser due to faster healing and recovery as well as less complication.

Laser Punch graft Punch elevation subcision Derma-brasion Micro-dermabrasion Derma-Filler Steroid jab
Ablative:

CO2—Boxcar, rolling scar

 

Non-ablative:

Nd YAG—Boxcar, rolling scar

Pulsed dye—keloid

 

Ice-pick scar Boxcar scar Rolling scar Rolling scar

Not ice-pick as it worsen due to wider base

General facial

Boxscar

Boxscar

Rolling scar

Hypertrophic scar

Keloid scar

Acne Scar Treatment: Micro-dermabrasion

Acne Scar Treatment by microdermabrasion is far less effective because the treatment only touches the epidermal layer.

This is completely different from Dermabrasion in that this treatment is gentler as it only treats the surface. However, the result is also lesser and slower to achieve. The system employs the blasting of very fine Aluminium oxide crystals onto the skin surface to peel off the outer dead skin layers. At the same time, the vacuum created on the returning end sucks away the crystal and the dead skin at the same time. This procedure is done mostly by the general beauty salon. Multiple sessions is required for showing some result. Mild rolling scar is the usual indications, together with the general facial treatment.

Acne Scar Treatment: Dermal filler

Acne Scar Treatment by dermal filler is an option. This is possible by using smaller molecular size filler materials.

This is employed to fill up the volume deficit in such scar like the Boxcar scar after the subcision. The material are human or animal derived collagen. Nowadays it can also be plant based products. Others like hyaluronic acid can be used. The only drawback is that this material does not last very long and therefore it needs to be repeated.

Another filler is the use of own body fat as filler material. This is called autologous fat transfer or transplant.

Acne Scar Treatment: Steroid injection treatment

Acne Scar Treatment by steroid injection is most effective for those keloid on the truck and body. It can also be used for severe keloid on the face.

This is mainly used for hypertrophic scar or keloid scar. The steroid is injected directly into the keloid lesion. It brings about softening and regression, eventually flattening of the scar. The procedure need to be repeated several sessions. This is because over dosage will cause depression which can be even more difficult to treat. The skin may be thinned excessively causing the change in colour and texture. Always go slow and titrate the dose slowly. Is better late than over correct.

Using surface applicable cream or tape impregnated with the steroid may be used but they are far less effective, only indicated for minor scar.