To the chagrin of many teenagers as well as adults, Acne is incredibly prevalent. This skin condition is thought to affect up to 80% of people in their teens and twenties and as much as 5% of adults. While most people survive their acne, some are left with disfiguring scars ranging from subtle textural changes in the skin to very noticeable deep pock-mark scarring.
Once an acne breakout has healed, it often leaves behind a red mark on the skin called a “post-inflammatory change”. Although this mark may eventually go away, it often takes from 6-12 months to do so. If inflammation and contour change persists, the result is a permanent acne scar.
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So how do we treat these early acne scars? The answer is through a number of approaches. First, to prevent hyperpigmentation of the lesion, use a good sunscreen to limit your sun exposure. Next, by using a Retin-A type product, you can actually speed up the skin’s remodeling process and potentially accelerate healing of post-inflammatory changes. Next, use of specific topical Alpha & Beta Hydroxy acids can also aid in speeding up healing. Finally, by avoiding picking at any scabs, you can prevent interference with local healing and avoid deepening the local injury.
Those scars that do not heal and fade are then defined as either Icepick, Rolling, or Boxcar scars based upon their specific appearance. Many people will have a combination of these scar types and, as such, may require combination therapy to achieve the most optimal result.
Current treatment of acne scarring may include one or more of the following approaches:
Dermal fillers
-this treatment utilizes filler agents injected into and beneath scars to raise the surface of the skin and produce a smoother overall contour. Examples of fillers can include fat, collagen, Hyaluronic acid derivatives (e.g.: Restylane, Juvederm, Captique, Hylaform), Poly-L-Lactic acid derivatives (Sculptra), or polymethyl methacrylate products (Radiesse).
Punch excision
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-using a round punch biopsy device, individual scars are excised and the resulting defect is then sutured closed.
Punch elevation
-this is a similar approach but the scarred tissue is not removed but allowed to float to the surface where it is then sutured to the surrounding tissue.
Laser resurfacing (ablative vs. non-ablative)
-contour irregularities of the skin can be effectively managed by removing the superficial skin layer (ablative) or by creating specific areas of tissue injury within the skin layers and ultimately tightening surrounding skin and stimulating new collagen growth (non-ablative).
Subcision (subcutaneous incision)
-scarred skin is generally the result of tissue loss and scar banding that effectively tethers acneic areas to deeper underlying tissues. To release these scars, small needles can be used to break up the bands and allow the tissue to essentially float up to the surface.
