Acne Scar Treatment, Acne Scar Removers /Procedures: Discussion of Options and Hope for the Future

Acne Scar Treatment, Acne Scar Removers /Procedures: Discussion of Options and Hope for the Future

Acne Scarring can make a tremendous impact on a person’s appearance and self-esteem. Often occurring during the crucial adolescent ages, perhaps the biggest impact is on one’s psychological and emotional health. Mild residual scarring sometimes can lead to tremendous mental scars more than what is reflected in the actual physical appearance of the scars. Knowledge of this can help those who may have mild physical scars but yet are mentally more dysfunctional. With this knowledge it may be possible to improve on the mental aspects and consequences from the scarring even more so than what physical treatments (plastic / cosmetic surgery, skin care, etc.) can improve. It can also possibly allow more improvement at this level just by getting the person to realize that this phenomenon is happening.

Although our treatment of this subject is more on the physical improvement of these acne scars, we wanted to mention the psychological aspects to better help people who are trying to improve their acne scars. Through our experience, even when the physical aspects are improved, what lingers and usually what is more impactful is how the person responds mentally. Both the treating physician and the patient need to be aware of this and be able to deal with this as well during the treatment process.

The physical options of treating Acne Scars include more aggressive skin care, microdermabrasion, dermabrasion / dermasanding, excisional means, subcision, volume replacement through injectable fillers and fat injections, Young Volumizer, resurfacing with cO2 lasers and chemical peels, facelifts, skin grafting, and facial implants.

Skin care is important to the medical care and prevention of Acne. Based on scientific evidence, prevention is strongly centered on the use of Vitamin An and the different variations of this topical form of the vitamin. Retin – An is the most common. The topical medicines prevent the buildup of cells in the hair follicle ultimately preventing the clogging of the pore and subsequent infection. There are anti-inflammatory properties that keep the situation from getting out of control and causing greater infection and more scarring. Salicylic acid cleansers are an integral part of the skin care. Next in line with this approach is the use of oral and topical antibiotics such as clindamycin, and the cyclines (tetracycline, doxycycline, etc.). The addition of alpha and beta hydroxy acid lotions help in keeping the pores disinfected and bacterial counts low. We usually suggest adding an at home glycolic peel to help keep the skin fresh and the skin turnover fast.

More critical medical treatments consist of oral tretinoin (Vitamin A) commonly referred to as accutane. There are many risks with this medication but it has helped some difficult cases. Consistent follow up is necessary as there can be systemic effects and consequences with being on this oral medicine. There are also some hormonal treatments that can be started including birth control pills and spironolactone act by working on preventing testosterone from stimulating the hair follicle and the production of sebum which can plug the ducts and give nourishment to the bacteria Propionibacterium acnes that leads the cascade of acne development.

Acne Scar treatment is difficult and the journey can be arduous. Multiple treatments are the norm. Most therapeutics has been centered on cO2 resurfacing but other treatments are taking some more prominence. We are going to explain the medical choices here in more detail.

Excision is a technique of excising the scars out and reclosing the area to try to make the scar much smaller. The goal is to close the area into as little of an incision as possible. The closer the closure is the better the outcome. There are multiple different ways to do this. We like to use the geometric line closure to improve the outcome. This type of closure entails arranging the scar into geometric patterns to break up the linear pattern that many scars take up. The eye and brain sees a pattern for any line that is longer than 0.7cm. So if it is longer than that you could benefit from some geometric closure to break up that shape and randomize it so the eye and brain cannot put together that there is a scar there. A simple closure is also an option but with the above caveat in mind. Sometimes if the lesion or scar is small, you can often times incorporate a z plasty. This essentially is a simple way of breaking up the scar in such a way that it is closed in the pattern of a “Z”. So the main goal of excising a lesion / scar is to make it look smaller and to help camouflage the scar better with the surrounding skin and tissue. This approach is more indicated when the scar is considerably wide, elevated, depressed, of a different texture, and noticeable. If the scar doesn’t have those attributes and is fairly level with the skin the better approach will be more with a resurfacing procedure like cO2 laser resurfacing, chemical peel, dermabrasion, or dermasanding.

Resurfacing is good because it allows the skin to resurface and grow over the parts of the skin that are abraded or removed with either cO2 laser resurfacing, chemical peel, dermabrasion, or dermasanding. The abrasion and removal part removes the scarred unwanted portion and allows new skin to grow over those areas. The result intended is an improvement in the appearance of the scar. Resurfacing is good when the level of the scar is near the level of the surrounding area. The greatest difference in the level of the scar and normal skin, the more the excision might be a better option. Resurfacing is a great option to do after the excisional components / procedures. Resurfacing techniques can also be used for ice pick scars by causing the tissue to build under the depression to raise the scar to the level of the surrounding normal skin as well. This is done with 80% trichloroacetic acid and the use of a pointed instrument, (toothpick, etc.). This same approach can be done with lasers directed to the depths of the ice pick scars and through repeated passes. Dermabrasion and dermasanding is a process where you use a rotating wire brush and sterilized sandpaper, respectively, to abrade the surface skin. All resurfacing works the same, you apply each method to take down the layers of skin to eventually allow new skin to resurface the area and create the beneficial effects in the process.

Fillers are an option for depressed scars through their activity of filling under the depression and raising it to the surrounding area. Fillers are usually temporary like restylane (6mo – 1 yr), juvederm (6mo – 1 yr), radiesse (1 yr- 2 yr), perlane (9mo – 1 yr). There are times when the fillers allow tissue to grow in place of the filler as they get metabolized. This is a minimally invasive way to get improvement to acne scars and attractive to some because of the quicker recovery.

Fat injections are a great option for improving Acne Scarring. By harvesting fatty tissue from another part of your body and then injecting it into your face can do many important things for the scarring initiated by Acne. Through Acne, the scarring can be pervasive. It can be on the surface of the skin which is easily seen. It can also be under the skin which is not as easily seen. The scarring decreases the vascularity to the area over time. This makes healing from treatments more difficult as well. The scarring and decreased vascularity makes the excisions heal less well along the incision lines. It also makes it harder to achieve a better closure. A better approach can be fat injections prior to more invasive scar revisions such as excisions. The fat injections also break up the scars to allow the depressed scars to become released and become more raised and look better. The fat injections also bring stem cells and this brings some rejuvenative potential to the scarred skin to help it heal. From a physical standpoint, the layer of tissue allows the skin a break from the muscle movement. The cells in the skin, which are continually remodeling the skin, will remodel and reconstruct the skin now with the rest from the muscle movement and continual stress from this association.

A face lift is an option to improve acne scarring by decreasing the amount of skin in the area of the face. This is the simplest way to explain the reason that a facelift can benefit acne scarring. As you age, the face loses volume and due to this you will have more skin per deeper tissue (facial skeleton and deeper tissue). This extra skin will allow the scars to become deeper by simple extra skin folding into the scars. This will also allow the scars to conglomerate to make them bigger from a bigger picture.

Facial implants fit into this category of volumizing to improve acne scarring through the same way as a facelift and fat injections can. The extra skin is taken up and the scars are pushed out more and stretched out more to make them look better.

Other options include subcision. This can be done with a needle or cannula placed into the skin through a very small entry site. The needle is then advanced under the scar depression and manipulated back and forth to cause future scarring underneath to raise the scars up and improve the depression. This is ideal when there is a large area of depression. Doing this procedure, you can avoid excising large areas of skin and the attendant risks that this involves. The other way to do this is through fat grafting added with the subcision to add volume with fat instead of future scarring. In this setting, the fat serves to lift the depression up to the normal level. Subcision can also mean cutting the depressed lesion and elevating around the edges to allow it to heal in the more uplifted level. The uplifted scar is then closed to the surrounding area.

Another new approach is the use of a derma rolling. This is not a conventional approach and is more popular in Europe. It entails a type of lint brush roller with needles all around it. That is a simpler way to explain what it looks like. The derma rolling is rolled over the skin and the manipulation that it causes leads to tissue contraction in the deeper layers of the skin to cause skin tightening and subsequent improvement in the scars. The effectiveness has not been fully studied.

There are other options that have been mentioned such as fraxel and other lasers that work on tightening the deeper levels of the skin. All of these lasers bypass the surface and heat up the deeper levels. The intent is to lead to tightening in the deeper levels to get amendment in the scars. Intense pulse light which is concentrated light, filtered light, has also been touted to help. Of these options, intense pulse light is likely to get you the least results. Fraxel and the other lasers can get you some enhancement although subtle to moderate in terms of degree.

co2 laser resurfacing can also carry out the deep dermal heating and tissue tightening as the other lasers. Deep fx by Lumenis can do this and get the same and more results that the other deeper tissue heating lasers. This can help the acne scar. However more traditional means of cO2 laser resurfacing gets better results.

Combining these treatments is another way of optimizing results. We have found the best approach is through stages where 1.) fat grafting is the first thing started 2. then subcisions, excisions, deep chemical ice pick peeling 3. the last stage is carrying out the co2 laser resurfacing with dermabrasion for the deeper scarred areas. We combine dermabrasion dermasanding to bring the resurfacing to a deeper layer in a more controlled fashion.

Acne treatment for scarring is a challenge but improvements in your scarring can be done. Patience is a virtue. Realistic expectations are a must. The key word is improvement and not perfection. Psychologically, it may be helpful to get some evaluation in the mental effects that the scarring has brought to the patient. This part of the healing process can play a major role in getting people who have suffered from acne scarring the confidence they need to know that much of their experiences and the way they feel about themselves may not be from the acne scarring.

This article is written by Dr. Philip Young M.D. the recipient of the Sir Harold Delf Gillies Award from the American Academy of Facial Plastic and Reconstructive Surgery. He went to Tulane Medical School. He completed his residency in Head and Neck Surgery at the University of Southern California. His fellowship traiing in Facial Plastic and Reconstructive Surgery was done in Shreveport, Louisiana. He currently practices Plastic Surgery in Bellevue, Washington.

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Question from m3rcali: I have Acne Scars. I research about it and I found two treatments:”MEDERMA” and “TEA TREE OIL. which one works

Best answers:

Answer by cutie306
I’m trying mederma right now. What kind of acne scars do you have? Poc marks? Or the red/brown ones that are suppose to fade with time? I think that Mederma will only help the red/brown ones.

Answer by CuriousFather
tee tree oil will not remove pock scars, but it will clean your face good and make your eyes water (like putting raw onion on them!)

Answer by Ron Shelf
Don’t know about those products but from what I know there are 2 kinds of treatments:

1. Home remedies

2. cosmetic surgeries.

You can read all about cosmetic surgeries for scar removal here http://www.bestoflook.com/cosmetics/Acne-Scar-Removal.aspx

or you can try some home remedies here http://www.grannymed.com/meds/scars.aspx

Here are some remedies you can make at home:

# Smear Vitamin E Oil Caplets on the scarred area.

# Smear some tea tree oil on the scar to help it heal faster.

# Put 1-2 drops of lavender essential oil on a cotton ball and apply on scar.

# Blanch green tea, soak a cotton ball and apply on the scar to help it heal.

# Mix Aloe Vera and vitamin E gel caplets and apply to the scar.

Know better? Leave your own answer in the comments!

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