Acne

Acne scarring management requires a dermatologist's "reservoir" of treatment options, which need to be "taylorized" to the individual's needs.  A specialist dermatologic surgeon is the most suitable individual to assess your needs, and recommend what treatment might be appropriate for you.

Treatment of acne scarring cannot begin until all active acne has been treated and observed for at least six months following initial total clearance.  Your acne scarred skin will never be restored to totally normal appearance, but with a combination of treatments specific to your requirements, significant improvement can definitely be achieved at the Skin Specialist Centre clinic.

Types of Acne Scars

There are a number of different-looking scars caused by acne:

• Ice-pick scars (deep pits).  Ice-pick scars are narrow, sharp scars that make the skin appear as if it has been punctured with an ice-pick.  They are narrow and less than 2mm and extend into the deep dermal subcutaneous layer.  They respond well to TCA technique (see below);  and surgical removal.
• Box car scars - these are angular scars that usually occur on the temples and the cheeks and can be either superficial or deep and are similar to chickenpox scars. They are oval depressions that have sharp, vertical edges.  Unlike ice-pick scars, they do not taper.  They are usually 0.1 - 0.5mm in depth and can be treated with conventional skin resurfacing techniques.
• Rolling scars (scars that give the skin a wave-like appearance).  These occur as a result of tethering of otherwise normal appearing skin to the subcutaneous tissue below.  Conventional skin resurfacing techniques do not work on rolling scars and they must be corrected by breaking up the subcutaneous fibrous bands.
• Hypertrophic scars - these are thickened scars.
• Macular scarring - this is characterized by flat areas of decreased and increased pigmentation as a result of acne.  No indentations are associated with this.

Treatment of Acne Scarring

The treatments listed below (either alone or in combination) should achieve significant improvement in your acne scarring, but will be dependent on the individual:-

1. Fraxel Laser System

This newly introduced technology stimulates collagen regeneration.  Usually five treatments with the Fraxel laser at four weekly intervals are required for this.  This laser significantly helps to smooth all acne scars.

2. Subcision

Subcision is used to break up fibrous bands that cause rolling scars.  This technique is performed under local anaesthesia by inserting a needle under the skin that is parallel to the skin surface.  It is essential that a dermatologic surgeon performs this procedure as the needle must stay in the plane between the dermis and subcutaneous tissue.  The needle is gently advanced or retracted in a piston-like motion, cutting the tethering bands.  The procedure causes bruising which fades within seven days.  This approach, where appropriate, achieves significant improvement, usually within two to three sessions.  Rolling acne scars respond particularly well to this technique.

3. TCA Cross

With this procedure, high-strength trichloroacetic acid is placed into the ice-pick scar area, resulting in the production of new collagen and re-modelling of existing collagen to fill the scar.  The treatment is localized to the ice-pick scar only and not the unaffected skin.

4. Dermal Filler Injections

Dermal fillers such as Restylane can be injected into acne scars to raise the surface of the skin and give a smoother look.  The injection of such materials does not permanently correct acne scars, so further injections are necessary.   This would need to be repeated regularly every six to twelve months depending on the site of the lesions.  Consideration can also be given to fat transfer into the areas.  Rolling acne scars respond well to dermal fillers.

5. Punch Excision

This can be used for deep scars, such as ice-pick or deep box-car scars.  A punch biopsy is used, which is like a cookie cutter tool that has varying diameters from 1.5 - 4mm.  The size of the punch biopsy is matched to the size of the scar to include the walls of the scar.  Following local anaesthesia, the scar is excised with the punch and the skin is sutured together.  If it is noticeable following this procedure, the area can be treated by various resurfacing techniques.

6. Punch Excision with Skin Graft Replacement

With this approach the scar is excised with the punch biopsy instrument as above.  Instead of suturing the skin edges together, a punch graft is usually taken from behind the ear and placed in the resulting punched out defect.