19 Aug Acne Scar Treatment
Acne Scar Treatment
A scar is the skin’s normal response to an injury of or through the dermis. The skin replaces the normal basket weave of collagen with linear or parallel fibers of collagen. These collagen fibers are placed across a wound to best hold the wound together and reduce the risk of the wound reopening. While this pattern for wound healing is effective, parallel collagen fibers don’t have the same elasticity and can pucker or pull the skin abnormally. While the epidermis eventually grows over to cover the wound, it lacks any specialized cells, such as hair follicles and melanocytes. The absence of melanocytes gives mature scars their pale appearance. When the scar is from a recurrent inflammatory process, like acne, the fibers can become even more disorganized.
Acne scarring has four basic types: ice pick, box car, rolling and hypertrophic. An ice pick scar is deeper than it is wide and often adheres to the underlying subcutaneous tissue. Box car and rolling scars from acne are both wider than they are deep differing only in the slope of the sides; box car are abrupt and rolling are gradual. A hypertrophic scar has too much collagen and appears raised on the skin but still exists within the original boundary of the injury.
Due to the anatomy of acne scars being at multiple levels in the skin, scarring is best treated using a multifaceted approach. At De Luz Medical Aesthetics we have developed a protocol to help minimize the appearance of acne scarring. We use a combination of low level light therapy with LEDs, chemical peels, home microneedling with topical O Cosmedics, in office deep microneedling, radiofrequency treatments with the Venus Freeze, filers where needed, and surgical subcisions and injections. While acne scarring most commonly occurs on the face, the scarring can be treated anywhere on the body.
The low level light therapy uses red and infrared LEDs to stimulate fibroblasts at different skin levels. The fibroblasts increase in both number and activity. The red LED also has an anti-inflammatory effect on the skin to promote healing.
The modified Jessner’s peel removes the outermost layers of epidermis. This peel results in smoother skin, removes some uneven pigmentation, and helps to reduce breakouts.
Home microneedling on a daily basis stimulates the development of a healthy epidermis. The addition of the niacinamide-rich B3 Plus, the Comfort Cream and the Potent Retinol Serum to the home care regimen further nourish the skin.
Deep microneedling is done in the office after placement of topical anesthetic. Numbing the skin allows for a comfortable microneedling down into the dermis. Microneedling into the dermis promotes wound healing in the dermis. This wound healing adds and reorganizes collagen, known as Collagen Induction Therapy (CIT), in the dermis helping to firm the skin.
The Venus Freeze uses radio frequency and magnetic pulses to warm the dermis. This gentle heating also promotes CIT and speed healing with improve blood flow to the skin.
At times while waiting for your skin to produce its own collagen, injectable fillers, like hyaluronic acid, can be a bridge. The fillers are injected into areas with a change to the contour of the skin. The filler then supports a pre-scarring contour to the skin while waiting for your own collagen to fill in.
Finally, subcision and injection surgery are for specific cases only. Some ice pick scars adhere to the subcutaneous structures. Subcision surgery cuts these adhesions to allow for smoother skin. Some hypertrophic or enlarged scarring can benefit from direct injection of corticosteroids, like Kenalog, and epinephrine. The injection of corticosteroids into a scar will help to shrink the scar.
Thank you for your time and attention,
Robert Zieber, MD
De Luz Medical Aesthetics