[By Theresa Ho]

Acne is perhaps one of the commonest skin condition known, affecting up to 80% of those from puberty to their early 20s and up to 5% of older adults. While it seldom impacts greatly on the general health of affected individuals, acne can have tremendous untoward bearings on the social and psychological well-being of many. The majority tend to recover from acne without any permanent effects, but a sizeable handful are left with disfiguring acne scars. Scarring is part of the natural healing process when our skin works to repair wounds. If the acne is severe, the more chance we have of getting noticeable marks and scars when the active lesions healed. There are some topical skin care products and medications that can improve mild scarring, but otherwise, the appearance of most acne scars can only be improved with skin resurfacing procedures, at times combined with surgical means. If you happened to be one of the unfortunate souls plagued with acne scarring, here’s a round-up of the best 5 ways to treat acne scarring, to help restore a pockmarked face and the confident to face the world without a ton of concealer.

Deep exfoliation with chemical peels

After an acne lesion or a pimple healed, it can leave a dark or hyper-pigmented mark on the skin. Strictly speaking, this is not a real scar, but rather a post-inflammatory change known as Post Inflammatory Pigmentation or PIH. This hyperpigmentation is seen as the skin goes through its healing and remodeling process, which can take up to 6 months or more. If no more acne lesions develop in that area, the skin can heal normally and revert back to its original state and color. Professional Chemical Peels are excellent not only for lightening these post inflammatory marks but help to reduce oiliness and control new acne outbreak at the same time. In addition, it tackles open pores, uneven skin tone and fine lines at the same time. A chemical peel is just as it sounds, different types of fruit acids are used individually or in combination to slough off dead skin cells from the surface so as to increase cellular turnover for new skin to regrow, and can be done at monthly interval by a qualified aesthetics physician to restore a blemish free complexion.

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Laser Peel to the rescue

A great option to chemical peeling to treat Post Inflammatory Hyperpigmentation and mild acne scarring is with a Laser Peel either as a standalone procedure or part of the comprehensive  Pore Perfection Program. This completely new approach to skin rejuvenation resurfaces and replenishes the skin at the same time with the use of gentle yet deep penetrating laser energy to exfoliate the rough and damaged outer layer of dead skin cells marked with mild acne scars. By shrinking down the sebaceous glands, laser peels will thus help to reduce surface grease, minimize pore size and refine skin texture. If you are looking for a safe and effective way to slough off dead cells, deal with discoloration and shrink those pores without using harsh chemicals and with virtually no downtime; there are more than a few good reasons to schedule a laser peel today and get back your glowing complexion.

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Non-ablative Fractional Laser Resurfacing

Acne scars are classified as icepick, rolling, and boxcar based on their appearance. Here’s a brief description to help you roughly identify yours but this is best done by a qualified practitioner or dermatologist.

1. Icepick scars are narrow and sharp, so called as they give the impression of the skin surface being punctured with an icepick. They are usually narrower than 2 mm and extend into the deep dermis. Icepick scars are notoriously difficult to treat as they are usually too deep to correct with skin resurfacing treatments.

2. Boxcar scars are round to oval depressions that have sharp vertical edges. Unlike icepick scars they do not taper to a point at the base. Shallow boxcar scars are 0.1-0.5 mm in depth and can be successfully corrected with laser resurfacing techniques while deeper ones might need to be further treated with subcision or other surgical forms of full thickness treatment.

3. Rolling scars occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance. They should be corrected by breaking up the subcutaneous fibrous bands with subcision and when combined with laser resurfacing, the results are often gratifying.

The non- ablative Fraxel Dual Laser system is the world’s premium fractional resurfacing laser that represents a new breakthrough as it offers patients the positive results of ablative resurfacing with the low-impact benefits of non-ablative therapies. Unlike old ablative lasers that remove the top layer of skin, this innovative system produces tiny, microscopic sites of thermal impact separated by areas of unaffected, healthy tissue when it’s applied to the skin. The spared healthy tissue between treatment zones contains viable cells that jump start and promote rapid healing of the outer skin layers and thus tackle moderate to severe deep acne scarring.

“Clinical studies suggest that 3 to 5 treatments spaced about 4 to 6 weeks apart is required to produce a gradual remodeling of dermal matrix components,” explains Dr. Chua Han Boon senior medical consultant with the SW1 Clinic (formerly from The Sloane Clinic). “The skin repair procedure for treated skin and scarred tissue is accumulative and patients do continue to show improvement 1 to 3 months after a course of successive sessions.”

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Ablative CO2 Laser Resurfacing

The most popular laser types used for resurfacing of acne scars are the carbon dioxide (CO2) and erbium:YAG (Er:YAG) lasers and they remain the gold standard for treating severe acne scarring. Lasers work by essentially burning the top layers of skin to a precise depth. The skin then heals, replacing the burned layers with newer appearing skin. However, the correct post-operative care of skin that has undergone laser resurfacing is a fairly long drawn process with significant downtime not acceptable to many. Things are changing with recent advances made in laser technology. Unlike traditional CO2 and other ablative laser resurfacing technology, SmartX laser combines advanced fractional CO2 technology with a high-speed computer scanner to deliver a precise matrix of micro-laser pulses which erase skin imperfections and activate skin rejuvenation, while facilitating rapid skin healing with results that rival or are even superior to those achieved by traditional ablative options but without the much dreaded downtime. As a bonus to scar treatment, what patients notice and love is the immediate tightening of the skin! This is consequent to the immediate contraction of collagen fibres which reduces wrinkles and loose skin, and skin laxity is noticeably improved even after a single session.

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Minor Surgical Correction

There are two minor surgical procedures that can be employed to deal with scars that are known to respond poorly to laser resurfacing techniques.

1. Subcutaneous incision, also known as Subcision, is used to break up the fibrous bands that cause rolling scars. Subcision is performed under local anaesthesia by inserting a beveled needle under the skin so that it is parallel to the skin surface. Staying in the plane between the dermis and the subcutaneous tissue, the needle is gently advanced and retracted in a piston-like motion to cut or break the tethering bands. This procedure causes bruising which may take 5 to 7 days to fade away.

2. Punch excision is another method of surgically correcting acne scars that is performed at the SW1 Clinic registered Aesthetics Surgery in Singapore, especially for deep ones such as icepick and deep boxcar scars. This procedure uses a punch biopsy tool which is basically a round, sharp “cookie-cutter” instrument. The size of the tool is matched to the size of the scar to include the walls of the scar and under local anaesthesia, the scar is excised with the punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable.

These surgical modalities usually give remarkable results when done in combination with laser resurfacing techniques.

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