Do acne scars make you want to hide?
A scar is a permanent mark left after the healing of an injury or disease process.
If you have moderate to severe acne, there can be extensive damage to the surface and underlying layers of the skin. This can leave you with flat, discoloured scars or a variety of other forms including pitted or indented skin and thick raised scars.
Some scars improve over time, others stay the same, and some can get worse with time.
Although you can usually disguise scars with makeup, the scarring is a permanent reminder of your experience with acne.
You can prevent scarring with early, effective treatment. Picking or squeezing pimples can also cause scars – so please, avoid the temptation to do this!
If you have a family history of scarring acne, it’s especially important to consider early treatment and review by a dermatologist.
Some of the treatment options for scarring include:
- Skin resurfacing and other laser and non-laser treatments
- Injectable fillers or implants
Lasers have largely replaced earlier resurfacing techniques such as harsher forms of chemical peels and dermabrasion for acne scarring. Light chemical peeling and microdermabrasion are gentler varieties of these procedures and are still popular for milder issues.
Treating acne scars
Lasers, lights and fillers are often used to treat acne scars.
For acne scarring, lasers and other energy-based devices have largely replaced earlier resurfacing techniques such as chemical peels and dermabrasion.
When choosing an acne scar treatment, look at what is known about the long-term safety and risks of each therapy.
Dermatologist and All About Acne member Dr Phillip Artemi says there is a range of ways acne scars form and several ways to deal with them.
Laser Skin Resurfacing
Carbon dioxide or Erbium lasers are used on a variety of scars to carefully remove a controlled amount of the damaged outer layer of skin. It can repair the surface layers and stimulate new collagen formation, which provides structure and strength to our skin.
Skin resurfacing can soften the scar, even out discolouration and produce a smoother and tighter skin appearance.
New treatments using ‘non-ablative’ (non-wounding) lasers to stimulate new collagen production do not damage the top layer of the skin and may be used for soft, indented scars.
Fractional laser treatment
Fractional laser treatment, sometimes also known as fractional resurfacing, is a treatment for improving skin texture and blending-in imperfections such as acne scarring.
Beams of laser light penetrate ‘pixel-fashion’ very deeply into the skin causing remodelling in all layers down to the depths of the scars. Treatment can be 'ablative' (wounding) where there is vapourisation of these pixels of tissue or 'non-ablative' where no wound is created.
A series of treatments is required, each causing redness and swelling for up to a week for the non-ablative treatment and longer for the ablative treatment. The full skin surface is not removed, unlike previous laser resurfacing techniques. Special ointments or skin care may be advised after the treatment.
Fractional laser treatment is usually conducted after an anaesthetic cream has been applied for quite some time (over an hour) or a local anaesthetic has been injected. Some treatments may require sedation.
Fractionated laser treatments may be called 'ablative' when it physically removes a column of affected tissue or 'non-ablative' when the laser injures the column of treated tissue, allowing it to repair and remodel without physically removing the tissue.
There are many different wavelengths that may be used for this purpose with the common theme being that the columns of damage must be deep enough to allow truly, deep dermal tissue repair and remodelling.
Much like the fractional laser treatments, radiofrequency can be used to treat acne-scarred skin.
Radiofrequency tends to have a similar ‘pixel’ effect on the surface of the skin but has a larger effect in the deeper layers of the skin. This may lead to a greater effect on the scars with less downtime compared with laser treatments.
Fractional radiofrequency may be delivered by just touching needles to the skin or inserting needles into the skin using insulated or non-insulated needles. The inserted needle fractional radiofrequency may allow a more focussed, deeper energy delivery.
Photodynamic therapy or PDT is mostly used for treating superficial skin cancers and precancerous lesions, but 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 special solution or cream containing aminolevulinic acid (ALA) – an amino acid, a building block of protein – is applied to the skin for an hour or longer. 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. Because 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. You will usually need a series of treatments.
The normal skin surrounding the acne areas becomes sensitive to light for the following two days. Bright light needs to be kept off the area during this time, which usually means staying indoors and keeping away from TV, computer screens and windows where the sun shines in.
This procedure is quite expensive so is not usually considered as a first option.
Kleresca, a form of biophotonic therapy, uses a blue light source and a chromophore transformational paste that has shown promise in both reducing acne and aiding in the healing of post acne lesions.
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 which are the lumps and bumps on the skin. You will usually need a series of treatments.
For acne, microdermabrasion is not regarded as a stand-alone treatment but may be used in association with topical or oral medications. If used alone for repeated sessions, it can make acne worse for some people with sensitive skin.
Microdermabrasion would only be considered for the most minor acne scarring conditions.
Indented scars can be plumped out with commercial products injected into the skin. Hyaluronic acid (Restylane, Juvederm, Esthelis) has replaced collagen because of its longer lasting benefits.
They are accurate, simple and effective techniques, however, they do not result in a permanent improvement and may have to be repeated or touched up.
Fat cells and tissue grafts can also be transferred from another part of the body.
Raised and thickened scars can be softened and flattened using steroids either applied to the surface of the skin or injected into the scar. Fluorouracil (a cancer medicine) has been successfully used to flatten scars by being injected into the scar.
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 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.