Cosmetic Dermatology: Acne Scars

Acne Scars

Acne scars are the biggest worry for any person who suffers with acne. This is especially worse if that person is a teenager.

Acne is an inflammatory process happening in the skin layers affecting the oil glands. This inflammation leaves behind a scar when it heals.

Types of Acne Scars:

Not all acne leave depressed scars fortunately. Inflammatory acne affecting only the upper layers of the skin will heal with mild pigmentary disturbance and shallow dish like scar. A deep seated inflammation going into the deeper layers of the skin and subcutaneous fat will result in ice pick and punched out scars . Often it can also lead to dermal scarring with uneven surface appearance.

How can these be corrected?

Treatment for Acne Scars takes into account the whole facial appearance in accordance with the expectation of the person affected. Unrealistic expectations lead not only to poor outcomes but also poor appreciation of the change in skin appearance.

Commonly employed methods for acne scar correction include:

Subcision : A process by which a blunt needle is inserted under a scar and moved in the horizontal plane breaking all fibrous bands underneath resulting in release of the skin from the underlying tissues. The skin surface then rises up secondary to a layer of blood that collects under it after the procedure. Usually one sitting is enough for most scars but some may need repetition.
Punch grafts : This is a technique whereby the depressed scar is cut with a circular blade and the skin is both lifted and placed back loosely in the same area or a punch graft from a different site is placed in the defect from the scar. This gives a good rise to the depressed skin which can then be treated with other modalities.
Chemical Peels : Pigmentary disturbance in superficial forms of acne can be more amenable to chemical peels like glycolic or its variants as per the skin type.
Dermabrasion : (or Microdermabrasion)This is a technique wherein the skin is polished with a sand paper or a mechanical machine containing aluminum oxide crystals. The skin surface feels smooth and glossy after the procedure. However, this has its downside with abrasions if done too vigorously and resulting pigmentary disturbance. It is not effective for deep scars.
Dermaroller : The use of a cylinder with sharp needles jutting out of it on the face gives me jitters. This has been often labeled as a ‘Medieval era torture instrument’. The skin needs numbing following which the dermaroller is moved in horizontal mode over the facial skin. It results in pinpoint bleeding from the surface. The skin heals slowly with formation of scabs on the surface. It is a painful procedure despite the application of numbing cream.
Laser Resurfacing : the last decade has seen the rise in use of Lasers for Acne Scar Resurfacing. The various Dermatology societies across the continents have now adopted Fractional Laser Resurfacing as the gold standard for treating this condition as it is the safest and most effective. They have been proven to be safe even on darker skin types. It is a painless procedure done in the consulting room as an outpatient procedure. With use of certain lasers there can be formation of scabs after the procedure. Usually upto 3 sessions are required to achieve the desired effects.
Dermal Fillers : The depressed scars can be filled with hyaluronic acid or collagen fillers to raise the surface. These are very safe synthetically prepared substances that mimic the body’s natural tissues. Often the dermatologist has to use a combination of methods to help a person with acne scars.

At Juvenis, the dermatologist goes through a detailed history of acne and examination of the person. The person’s expectations from the procedures are assessed. Following this a realistic plan is chalked out as per the needs of the case.

The clinic specializes in use of Fractional Laser Resurfacing in combination with subcision for Acne Scars.