Acne scar treatments

Scarring results from injury to the epidermis and the dermal layers of the skin. Acne scars most commonly occur as a result of intense inflammation such as rupture of the pilosebaceous unit or ‘pores’. Inflammation of the dermis disrupts the evenly ordered structure of collagen. Collagen is the scaffolding of the skin that gives it strength, tone and flexibility.

To repair the damage done to the dermis, one must remodel old collagen and reform new collagen-this is the basis of scar revision.

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Rolling scars

These scars appear as rolling undulations in the skin and occur as the result of tethering of otherwise normal appearing skin. A number of methods can be used to treat rolling scars including subscision, fractionated laser resurfacing and skin needling. These scars can be challenging to treat and often a number of methods must be used to achieve the best possible result.

Ice pick scars

Icepick scars, as the name suggest are sharp and narrow scars that extend deep into the lower layer of the dermis. These scars are too deep to correct with laser. Procedures such as punch excision or TCA cross can dramatically improve the scar.

Though laser has minimal impact on ice pick scars, fractionated laser/ fraxel is often used to treat surrounding scars. Most commonly patients will present with a variety of scars, and these will all need to be treated in a specific way. Once ice pick scars are treated, the surface can then be treated with laser.

Box car scars

These are depressed scars which have sharp edges that do not taper to a point (unlike ice pick scars) . These scars can be round, oval or linear and often occur around the temples and cheeks. Shallow boxcar scars can be treated with laser resurfacing, TCA cross or dermal grafting.

Macular scars

This form of scarring is characterized by flat areas of increased pigmentation. In most patients the areas appear redder then the surrounding skin. Patients with darker skin types will notice darkening of macular scars. The vast majority of macular scars will fade within 3-8 months. Patience, sunscreen and prevention of new lesions are key points of treatment. For macular scars that are persistently red, laser treatments, including IPL can be of benefit.

Hypertrophic and keloid scars

moreHypertopic and keloid scars

This type of scarring occurs when the body sometimes produces too much collagen, this in turn creates a haphazard array of collagen fibers. The aim of treatment is to slow down collagen production and to encourage ordered formation of new collagen in the dermis.  Corticosteroid injections and silicone gel gives a predictably excellent outcome. Fractionated laser can then be used once the scar flattens out. Vascular laser can reduce the redness.

Acne scarring is a specialist field in it self. Scars maybe present at different depths and types, and in different skin types. All cases of acne scarring are assessed individually and a treatment plan tailored to the clinical examination of the patient.

Treatments include –

• Fractional laser resurfacing / Laser resurfacing
• TCA cross for acne scars
• Subscision
• Skin Needling
• Vascular lasers for red scars
• Dermal fillers and grafts
• Steroid injections for raised scars

The successful treatment of acne scarring is a major challenge to treating specialist. For the patient acne scarring can be traumatic and distressing. In the past scar treatments have had limited success however with the evolution of new laser technology, patients can expect to see significant improvements with little down time. Fraxel or fractionated laser resurfacing has revolutionized acne scar treatments.

It is important to realize that patients will often have a mixture of scars and choosing a specialist skilled in performing all procedures will give the best outcome.

moreFractionated lasers treat a fraction of the skin surface

Fracionated laser treatment (Fraxel , ProFractional) produces hundreds of tiny but deep mico-columns of treatment into your areas of scarring. Each column is the diameter of your hair shaft. Laser ablates the scars and old collagen, but also leaves areas of your skin untouched,forming the basis ofFraxel/ fractional laser treatments. For every micro column the laser treats, it leaves the surrounding tissue unaffected and intact. This fractional treatment allows your skin to heal much quicker than if the entire surface was treated at once as the untreated area heals the wound by removing the treated skin and replacing it with new tissue.

moreFractionation treats a specified percentage of skin

The advantage of treating skin this way is that there is less downtime and side effects while obtaining a significant clinical improvement. This type of scar treatment is also safe in darker skin types such as in Asian skin.

With deeper scars, CO2 laser modulation can be used during fractionated laser resurfacing. With this technique more collagen stimulation is achieved, however down time approaches 7-10 days. Your treating specialist will discuss a treatment plan to give you the best possible results, and balance your downtime.

Fraxel was one of the first fractional machines developed; however since its use, numerous updates and advances have been made. After significant trials, the specialists at Westside Dermatology elect to use the ProFractional system over the older Fraxel system. Why? We believe that ProFractional offers significant advantages over Fraxel- namely, faster recovery, adjustment of depth of laser, less side effects such as darkening of treated skin- this results in better outcomes with quicker recovery times, whilst minimizing side effects.

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Skin needling / Roll Kit / Derm Rollers

With the event of Fraxel and Fractionated laser systems, the use of skin needling has seen a steady decline over the past 2 years. Skin needling uses a medical grade roller to puncture minute columns in the skin, reaching deeper layers to stimulate collagen formation. Several treatments are needed. Skin needling is safe on all skin types including darker ethnic skin. Fraxel and ProFractional systems generally perform 30-60% BETTER than needling.  Recovery time is in the order of 3 to 7 days. Expect to see between 20% to 30% improvement with each session of skin needling.

More information on skin needling

Chemical peels can be of benefit in cases of mild acne scarring. Glycolic acid peels can stimulate collagen early in the course of scar repair as well as improve skin texture. Once acne is under control with various acne treatments, patients have the option of the Clear Skin Program – a series of AHA peels alternating with Red Light LED treatment.

More information on the Clear Skin Program

NOTE- Clear Skin Program is ONLY suited for mild case of acne scarring and to improve skin texture. For moderate to severe cases of acne scarring- Fractional laser will give better long term results.

High strength TCA peels (TCA Cross)

moreFor deep ice pick scars TCA cross is applied before laser.

Amethod used for treating isolated deep ice pick scars. Application of high strength Trichloroacetic acid encourages collagen formation, lifting deep scars. Several treatments are advised. Ice pick scars are notoriously difficult to treat, they do not respond to Fractionated laser resurfacing/ Fraxel treatments. 

Dermal fillers / dermal grafting.

This method maybe effective in treating depressed scars. Fillers last 4-8 months. Dermal grafts for acne scars last longer.

Intense pulse light / Broad band light.

This is a form of ‘laser’ treatment, and can dramatically reduce red scars / macular scars. Combined with Fractional laser resurfacing, IPL / BBL can stimulate collagen formation. 

Microdermabrasion

Microdermabrasion can be used to treat mild blackhead/ comedomal acne, however it is NOT a recognized treatment for acne scars. Acne scars lie in the deeper layers of skin (dermis), whilst microdermabrasion only treats the very superficial layers of the skin (epidermis). We have replaced microdermabrasion with AHA Glycolic peels, due to the superior results of chemical peels.

Scar and cyst excisions

With deep scars and persistent cysts, excision maybe needed. Deep scars such as ice pick scars are best treated with either punch excision or TCA cross. Fractionated laser is NOT effective in treating this type of scarring however maybe used on the surrounding skin. 

Blue and red light treatments

These wavelengths of light have been effective in treating acne and acne scarring. Treatments are best conducted early in the process of scarring. Improvements can be expected in mild cases of acne scarring.  A series of treatments are advised. The wavelength of red light has been shown to stimulate collagen formation, and aid in wound recovery. We often combine LED treatments with Fraxel/ Fractionated laser resurfacing and chemical peels for added benefits.

Corticosteroid injections

This method is used to treat raised scars- hypertrophic or keloid scarring. These scars generally occur on the upper back, chest, shoulders and jawline areas and present as hard lumpy areas. Several courses of injections can flatten out these areas over time. The result is generally excellent. Fractional laser can also reduce the hardness of these scars, however 3-4 treatments are often needed.

Topicals / creams for scar treatment

Retinoids are generally used to treat acne, however they may also aid in collagen production. Dermatologist often prescribe retinoids topically (in a cream base) to maintain acne remission and in some situations help with collagen remodeling.

Sunscreens form the basis of reducing post inflammatory hyperpigmentation. Macular scarring (red flat scars) is greatly reduced by regular use of a non -comedogenic sunscreen.

Subscision

This surgical technique is often combined withFraxel / ProFractional laser systems to treat deep bound down scars. This technique breaks down collagen that puckers the scar downwards. The surrounding scar is injected with local anesthesia, and a needle is inserted to run parallel to the skin to deeper structures. Release of the bands that bind down the scar visibly lifts the scar, smoothing the skin’s appearance. Punch excision can also be used to treat deeper ice pick scars.

Red acne scars will often settle over a period of months. The use of Vascular laser such as V-Beam can reduce the redness over a period of a week or two.

We recommend 2-3 sessions for best results.

More on V Beam vascular laser treatments

Scar revision is best conducted when acne is under control. This ensures that new acne lesions do not scar. If acne scar revision is conducted when acne is still active, patients and dermatologist end up ‘chasing’ scars- a frustrating way to deal with scars for both!

More information on acne treatments

Certain types of scar revision such as corticosteroid injections and redlight laser – LED treatments are permitted, however treatments such as Fractional laser, subscision and chemical peels are NOT conducted whilst patients are on Roaccutane. Fractional laser/ Fraxel laser can be conducted 3-6 months after stopping Roaccutane/ Oratane, as the skin healing function has normalized after this recovery period.

Trusting a physician to revise scars can be daunting form many patients as acne scars can be a complex mixture of scar types.  Laser trained and procedural dermatologist are best equipped with expertise and the latest technology to give optimal results to our patients. At Westside Dermatology, all treatments are performed by our highly qualified Dermatologists, so you can be sure that you are in experienced hands.

Call us directly on (07) 3871 3437 to make an appointment, or to discuss issues regarding the referral process.

Enquire about acne scar treatments

Fractionted Laser/ Fraxel  and chemical peels are NOT covered under Medicare, however your dermatologist will advise you of other suitable treatments which are partially covered under Medicare

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Some acne scar revision procedures are covered under Medicare. Examples include full resurfacing laser. Fraxel and Fractional laser treatments are NOT covered by Medicare. Surgical and scar revision procedures, if undertaken by a Specialist in their field maybe partially covered by Medicare. Your Specialist Dermatologist will inform you of which procedures are covered.

moreDr. Davin S. Lim

Dr Davin Lim, Cosmetic Dermatologist

Confidence in the treating specialist is important for any patients undergoing acne scar revision. The use of the very best equipment, coupled with the best training will give far superior results. Due to the vast types of acne scarring, in addition to different skin types, acne scar revision will need to be individualized for patients to achieve the best results. I often use numerous methods in the one patient including punch excision of deeper scars, subscision, and Fractional Laser. Assessment, planning and discussion of treatments options are the very important prior to any acne scar revision process.

"I never thought that laser acne scar treatment was so affordable, nor did I expect the procedure to be effective" Chole G, Ascot

"Dr Lim walked me thru what to expect before, during and after laser surgery…very comfortable with everything. Very happy with the results" Bruce D, Gold Coast

"The severity of my acne scars depends on the lighting. After 3 treatments of laser, they aren’t nearly as noticeable. Well worth it…" Akira H, Cairns.

"Dr Lim was straight forward with the options available to me. 100% happy with treatments from the consult to after care." Chloe G, Ascot