Acne Scars
Acne scars, no matter how old or severe can be improved. The method of scar revision is aimed at treating each and every scar with the optimal treatment for that scar; for this reason, many treatment options may be necessary for optimal results such as chemical peels, surgery, subcision, lasers & other energy devices. Setting and managing expectations is key as certain scar types will take longer to treat than others therefore the goal is a “global improvement of the appearance of the scars.
Chemical resurfacing
Trichloroacetic Acid Chemical Reconstitution of Skin Scars or TCA CROSS is helpful for deep acne ice-pick scars, box car scars & enlarged skin pores. Most patients will require 2-4 treatments for best outcomes. TCA Peels and other Chemical resurfacing solution are helpful for superficial scars.
Laser Resurfacing
For superficial acne scars such as shallow boxcar and rolling scars, resurfacing lasers such as UltraClear are appropriate and should be used along with other treatments to achieve a global improvement. Typically laser resurfacing can be performed in one aggressive treatment session or a series of 3-6 sessions of a more gentle laser.
Subcision
This is a surgical procedure, designed to treat deep tethered acne scars including deep atrophic rolling scars. Subcision essentially breaks scar tissue from underneath. This entails mapping out areas, finding the level of scarring intra-operatively, & then applying instruments to treat those scars. Subcision treatment of acne scaring can be performed with specialized needles, cannulas or specialized subcision instruments. Based on the severity of the acne scars, injectable anesthesia may be required. In most cases, Subcision is performed along with other procedures such as TCA CROSS or laser resurfacing.
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Fillers
Fillers are excellent for the treatment of atrophic & depressed acne scars. The advantage of fillers is that results are instant and downtime zero. Some patients will require 2-3 treatments for best results, other patients will require only one session. How you respond depends on many factors including the depth, location of the scars, & whether depressed scars are tethered to underlying structures. For deeper scars, subcision is performed during the filling session. Adipose tissue or Fat can be used to “fill” and rejuvenate acne scars.
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Microneedling
Microneedling is an entry level treatment for acne scars. It gives modest improvements however It is especially useful for mild & early scars. Most patients will require 6 or more treatments for best outcomes.
Radiofrequency Microneedling
Radiofrequency Microneedling, like SylFirmX, is a more aggressive form of microneedling appropriate for most scar types and severity. This treatment uses fine needles that deliver controlled heating for a fraction of a second to the dermis (the layer of skin where acne scarring occurs) Radiofrequency Microneedling is much better than microneedling because HEAT is required for optimal remodeling of collagen. Most patients will require 3-6 treatments for best outcomes based on the severity of acne scarring.
Fat transfer
Much like fillers, fat can provide volume. All scar revision procedures are aimed at stimulating your immune system to regenerate tissue. Microfat & millifat transfer can repair tissue (dermal collagen & adipose tissue), destroyed by acne. Nano fat can improve skin quality. Fat also contains an abundance of stem cells that can help regenerate tissue.
Biostimulation treatments
Biostimulation involves injections of biomodulators & collagen stimulating injectables (not to be confused with dermal fillers). This treatment is helpful for atrophic rolling scar tissue, devoid of collagen & fat. Biostimulation works by upregulating your immune system to produce collagen. These treatments may take longer to see results, however, they may last longer than dermal fillers as the collagen you generate is yours to keep. Typically, 2-4 treatments over a period of 2-8 months are needed for ideal outcomes. The number of treatments needed are determined by your ability to generate collagen, the size of the scars, your age and the dermal thickness.
Surgery
There are varying types of surgery for acne scarring. These include Punch excision for very deep acne scars; Subcision for tethered and anchored scars; Excision for linear scars and bridging scars; Surgical elevation for broad scars. The utility of surgery for acne scars is to take a depressed scar and make it a flat/normally contoured area of skin. The decision to perform surgery is an individual choice based on the scar types. Typically, laser resurfacing or chemical resurfacing is performed after surgery to improve the appearance of surgical scars.