[By Xuan Li]
The majority tend to recover from acne without any permanent effects, but a sizeable handful are unfortunately left with disfiguring acne marks and scars. Scarring is our skins’ natural response to injury and when more severe acne lesions healed, scarring can be inevitable. If the hormonal upheaval of puberty has left its footprints though the teenage angst is long gone, here’s a round-up of the best ways to fix your acne scarring, to help restore a flawed complexion, and the confidence to face the world with your best face forward.
Deep exfoliation with chemical peels
After an active acne lesion or a pimple healed, it can leave behind 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 Hyperpigmentation 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 especially for darker skinned individuals. 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. True to its moniker, chemical peels are made from different types of fruit acids which can be used singularly or in combination to slough off dead skin cells from the surface, increasing cellular turnover for newer skin beneath to show through for a complexion that’s brighter, less flawed and more youthful looking.
Intralesional steroid injection
Acne on the chest can leave behind unsightly keloid scars in individuals prone to keloid formation
Acne scars most often look like small indentations on the skin, but sometimes the reverse can occur. Most commonly seen on the chest and back, keloidal acne scars are disfiguring and notoriously difficult to clear. Intralesional steroid injections have been used since the mid-60s for the treatment of raised keloids, flattening scars by softening skin and shrinking down hard scar tissues. The steroid used for intralesional injection for scar is triamcinolone (Kenalog), and it can be administered as soon as the problematic scar is identified. Although seemingly simple at first glance, Intralesional cortisone injection is not without its risks.The expertise and injection technique employed is just as crucial as the amount and dilution of the medication used, as there’s always a risk of fat atrophy with steroid injection(s) that can result in dimpling or converting the raised scars into atrophic scarring if not done properly.One drawback of steroid injections for raised scars is the variable response rate. Generally speaking, usually two or three injections that are given one month apart are needed to achieve the desired results and therapy can continue for six months or longer, as there is up to a 50% chance that the symptoms of your raised scar will recur.
VBeam laser for red acne marks
Inflammatory acne often leave behind red marks that are due to neovascularization or increased formation of new blood vessels that persist after the active lesions heal. The red discoloration of these vascular acne scars usually fade with time but this is not always the case, with some individuals ending up with undesirable looking scars. Widely considered by experts as the gold standard for treating blood vessels related skin conditions, the FDA approved Vbeam Perfecta laser is the most advanced Pulsed Dye Laser Technology that has the unique ability to deliver intense but gentle pulsed laser energy to selectively targeted blood vessels without adversely affecting the surrounding tissue, shrinking them to reduce the red skin stains. As part of the Scar Prevention Program, Vbeam can also be implemented immediately after suture removal to speed up the healing of post-surgical scars, greatly reducing the chance of hypertrophic and keloid scars formation in susceptible individuals. Best results are seen when the first session is instituted at suture removal to 1 week thereafter, with subsequent treatments carried out judiciously at 2 weeks apart for best results.
Resurfacing lasers are the game changers
The 3 different presentation of atrophic acne scars seen
Resurfacing lasers have completely revolutionized the approach to acne scar treatment, offering new found hopes to not being scarred for life. The most popular laser types used are the carbon dioxide (CO2) and erbium:YAG (Er:YAG) lasers, proven to date to be the gold standard for treating severe acne scarring. Resurfacing lasers work by essentially burning the top layers of skin to a precise depth, replacing the burned layers with newer appearing skin as natural healing takes place. Unlike traditional ablative laser technology, SmartX micro-resurfacing laser combines advanced fractional CO2 technology with a high-speed computer scanner to deliver a precise matrix of microlaser pulses which erase skin imperfections and activate skin rejuvenation, while facilitating rapid skin healing to achieve good results without the side effects, risks and much dreaded downtime of traditional ablative skin resurfacing lasers of yore. As part of the Scar Intervention Program, it works equally well for both surgical and non-surgical old scars that have already healed completely but may benefit from supplementary supportive therapy. Designed to address textural and colour issues, it’ll give skin regained strength and suppleness, helping existing scars blend into your skin like a clever “photoshop” tool.
Minor Surgical Correction
Subcision gives good results against rolling acne scars when done correctly
There are two minor surgical procedures that can be employed to enhance the results achievable from laser resurfacing techniques alone.
Subcision is used to break up the fibrous bands that cause rolling scars. Subcision is performed under topical +/- 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.
Punch excision is another method of surgically correcting acne scars 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.