Acne breakouts are bad news but the scars they leave behind can be more frustrating. Scars are formed when a breakout penetrates the skin deeply and damages the tissues beneath it. Each type of scar responds to treatment differently, and some treatments are better for particular types than others.
Post acne scars can be wide U shaped boxcar scars, narrow and deep V shaped scars or wide depressions with rolled edges called rolling scars.
As the name suggests, ice pick scars are very deep holes in the skin that look like the skin has been punctured with an ice pick. When the body produces too little collagen in response to an injury, depressed scars such as ice picks can form.
Treatment may include excising the scar with a small instrument called punch and suturing the defect closed, but this only works for isolated ice pick scars,
If there are multiple ice pick scars, acne scar treatment devices that use radiofrequency energy are a good choice.
These treatments help build collagen from the inside out, and collagen helps to fill the scars from within
Energy-based skin resurfacing with a laser, radiofrequency, or an ultrasound device can help treat boxcar scars, as they all work by creating new collagen beneath the surface of the skin. A series of treatments is likely needed based on the extent of scarring, chemical peels can also help but to a lesser extent. With either procedure, using a retinoid cream locally to increase cell turnover and further boost collagen can help to give better results.
Fractional non-ablative lasers are the newer technologies, and they have less downtime than older lasers, so this means surgeon can be more aggressive and see results with fewer treatmens. Older ablative lasers used to evaporate the skin's top layers, which requires longer to heal, but these newer non-ablative lasers like fraxel, pass through the skin's upper layers to harmlessly heat the deeper tissues, stimulating collagen and smoothing the scar's appearance with minimum downtime.
Microneedling is a non-surgical technique, which uses application of mechanical force to the skin, via fine needles, to stimulate the proliferation of cells. This new cell formation, lays down new collagen and elastin tissue, which improves the appearance of fine lines, wrinkles, stretch/scar marks, pigmentation or other irregularities in the skin. It also improves the blood supply by formation of new capillaries.
Rolling scars can be treated with microfat injections followed by microneedling with platelet-rich plasma (PRP), Microneedling creates tiny wounds or pinpricks in the skin. The body's natural, controlled healing process then kicks in to boost internal collagen production. Microneedling is also a great acne scar treatment because it opens up channels within the skin that give PRP—the healing factors in your own blood—and skin care products direct access to deeper layers of the skin where they're needed most. PRP is created by taking some of your blood, isolating the platelet-rich plasma, which contains proteins and other growth factors, and injecting it back into the scar. "The objective is to build up the collagen layer under the depression in order to raise it to the level of the surrounding skin. You'll likely need multiple treatments, but the results are worth it.
The treatment acne scars with hyper-pigmentation is with hydroquinone and sunblock, Hydroquinone is a topical bleaching agent that you apply directly to a dark spot. Sunblock is essential, since sun exposure can worsen hyper-pigmentation. Other popular treatments include glycolic acid creams which remove the upper-most layer of the skin and the dark marks, and retinoids to increase skin cell turnover
You have to take all of these factors into account, and I always advise patients that multiple treatments will be needed, and even after a year or two, a 50 per cent improvement may be expected.
The article has been authored by Dr. Anup Dhir, Senior Consultant, Cosmetic Surgeon, Apollo Hospital, New Delhi.
