Non Laser

Photodynamic therapy

Photodynamic therapy or PDT is a treatment which is most usually employed for treating superficial skin cancers and precancerous lesions; however it may also be used for treating acne and some inflammatory skin conditions.

After a microdermabrasion treatment which removes cell build-up from the skin's surface, a solution containing a special solution or cream containing aminolevulinic acid (ALA - an amino acid - building block of protein) is applied to the skin for about an hour. This is taken up more readily by the inflammatory cells and oil-producing glands and makes them more sensitive to light.

After this incubation time, light is applied to the area. This is usually a continuous blue or red light but may be an intense pulsed light or a laser. As the acne areas will have taken up the ALA more than the normal skin, they will be selectively treated. These areas usually flare up for a week or so and then settle. A series of treatments is usually required.

The normal skin surrounding the acne areas becomes sensitive to light for the following two days, so this means that bright light needs to be kept off the area during this time. For body areas, clothing is usually sufficient to do this, however for the face, it usually means staying indoors and keeping away from TV and computer screens and windows where the sun shines in.

This procedure is quite expensive so is usually not considered as a first option.

Micordermabrasion

This is a treatment that gives the skin a "cut and polish and a vacuum clean". It has a superficial "buffing" effect which smooths the surface and the suction cleans out comedones and pustules. A series of treatments is usually performed.

For acne, it is not regarded as a stand-alone treatment but may be used in association with topical or oral medications.

For acne scarring, it would only be considered for the most minor of conditions.

Fillers/Implants

Indented scars can be plumped out with commercial products injected into the skin.

Hyaluronic acid (Restylane and Juvederm) has largely replaced collagen because of its longer lasting benefits.

Fat cells and tissue grafts can also be transferred from another part of the body.

However, these techniques do not result in a permanent improvement and may have to be repeated or touched up.

Steroids

Raised and thickened scars may be softened and flattened by the use of steroids either applied to the surface of the skin or more commonly injected into the scar. Recently, fluorouracil (an anticancer drug) has been successfully used to flatten scars by being injected into the scar.

Surgery

Deep "punched out" scars can be cut out and closed side to side with stitches, while large raised scars may be improved by surgically removing them. Surgery may be performed prior to laser resurfacing which can sometimes help blend in and hide the surgical scars.

Subcision or freeing up of an indented scar is a valuable procedure when the scar is bound down to underlying tissues. Other so called 'punch' techniques include punch grafts - where a small graft is used to replace the scar or punch elevation - where the scar is punched and lifted up to a higher position in the skin.