Acne scars treatment
Above: Photos of a client before and after acne scar treatment at Dr Bob Clinic. Consent obtained for use of image. Photos are for reference only, individual results may vary.
Schedule an appointment
Acne is an extremely common condition affecting up to four out of five adolescents to a certain degree. Acne is characterised and caused by several pathophysiologic factors including Propionibacterium acnes activity, overproduction of sebum, androgenic stimuli, follicular hyperkeratinisation, cell-mediated inflammatory response, and cytokine activation.
Inflammatory acne lesions potentially result in permanent scars. Scarring occurs early in acne and may affect some 95 percent of patients with this disease, depending on the severity and delay before treatment.
There are three different classifications of acne scars: atrophic, hypertrophic, or keloidal. Atrophic acne scarring happens to be the most common type, and is an unfortunate long term complication of acne vulgaris.
Atrophic acne scars significantly impacts quality of life, and proves to be a therapeutic challenge for physicians. The pathogenesis of atrophic acne scarring is most likely related to inflammatory mediators and enzymatic degradation of collagen fibers and subcutaneous fat.
The most basic and practical system further divides atrophic acne scars into three main types: ice pick, rolling, and boxcar scars.
A range of options are available for the treatment of acne scarring, including chemical peeling, microdermabrasion, skin laser treatment, dermal fillers, subcision, and combined therapy. Various modalities are used to treat acne scars, but their limited efficacy and problematic side effects have restricted their application.
In order to achieve optimal treatment for acne scars, we need to consider which treatment offers the most satisfactory result. In this article, I will explain the different modalities for treatment of acne scars. I hope that you will find it educational, and will help you in making the decision together with your doctor on how to achieve the best outcome for your skin concern.
Silkpeel Dermalinfusion (Diamond Glow)
Dermabrasion was among the first major development in the treatment of acne scars. Dermabrasion is a skin resurfacing technique that mechanically ablates damaged skin thereby promoting re-epithelialization.
Silkpeel Dermalinfusion (Diamond Glow), a more superficial variation of dermabrasion, removes the superficial layers of the epidermis, accelerating the natural process of exfoliation. The system also delivers skin specific topical solutions to address multiple skin concerns including pigmentation, acne and wrinkles.
The active ingredients in these topical solutions are Salicylic acid in the Pore Clarifying Solution, Hyaluronic Acid in the Ultra Hydrating Solution, Lumixyl Peptide in the Skin Brightening Solution, and Vitamin C solution. You can also get the continuous benefits of Salicylic acid and Hyaluronic acid at home with Dr Bob Remedies range of skincare.
Silkpeel Dermalinfusion is proven effective in the treatment of acne scars and produces clinically significant improvements in skin appearance. Microdermabrasion can be repeated at short intervals, is painless, does not require anesthesia, and is associated with minimal complications. However, compared to other treatments here, the effectiveness is lower, and therefore is unsuitable to treat more serious scarring.
Microneedling RF is a minimally invasive technology involving the use of very fine microneedles to create microscopic wounds at various predetermined depths in the dermis, without damaging the epidermis.
The energy delivered leads to the creation of an array of miscroscopic wounds in the dermis interspersed between intact tissues. The direct thermal heating of the dermis results in neocollagenesis and subsequent thickening of the dermis.
Microneedling treatment is a safe, reliable and well tolerated technique for acne scar treatment with little to no downtime. The treatment generally takes 15-20 minutes and you can achieve visible results even with a single session.
Chemical peeling is a treatment where certain chemicals are applied to the skin to breakdown the outer damaged layers, thus hastening the normal process of exfoliation. Different agents produce different depths of penetration, and therefore, chemical peels are differentiated based on the histologic level of damage that they cause.
Salicylic acid is the best peeling agents for the treatment of acne scars. Salicylic acid is a beta hydroxy acid (BHA) agent, which removes intercellular lipids that are covalently linked to the cornified envelope surrounding keratinized cells.
Compared to other types of chemical peels, salicylic acid is lipid soluble. Therefore it is able to penetrate the sebaceous fatty material in hair follicles and exfoliate as well as unclog the pores.
Salicylic acid peels are recommended to be performed monthly. The side effects of salicylic acid peeling are mild and transient including erythema and skin dryness. Long term post-inflammatory hyperpigmentation or scarring due to the chemical peeling are extremely rare.
The advantages of salicylic acid include established safety in almost all skin types, frosting (formation of white precipitate) to show homogenous application, and a numbing effect that can be useful in combination treatments. The disadvantage of salicylic acid is an intense sensation of stinging and burning.
Subcutaneous incisionless surgery (subcision) is an effective treatment for rolling scars. In this procedure, a hypodermic needle is introduced into the subdermal plane to undermine the scar through a series of backward and forward motions, followed by horizontally rotating the needle in a fanning motion.
These motions loosen the fibrotic adhesions that cause rolling scars and create a wound environment that promotes collagen deposition. The bleeding and subsequent clot formation that result from the procedure elevates the skin from the underlying scar tissue, creating a potential space for neocollagenesis.
Although subcision is adequate as a stand-alone treatment, better results are achieved when combined with other modalities. By loosening deep fibrous attachments, subcision may make acne scars more receptive to other treatment modalities as part of a multi-step approach.
Soft tissue augmentation
There are many new as well as existing tissue augmentation agents that may be used for atrophic acne scar correction including autologous, non-autologous biologic, and even non-biologic agents.
Soft-tissue fillers are particularly effective in treating patients with rolling acne scars. Fillers for acne scarring can be utilized in two ways.
First, fillers can be injected directly under individual scars for immediate improvement. Hyaluronic acid skin boosters offer a reasonable duration of correction with reduced risk of immunogenicity and hypersensitivity. There is also evidence that hyaluronic acid with its biorevitalization action can promote cell proliferation and extracellular matrix synthesis as well as modulate the diameter of the collagen fibers.
Second, volumizing fillers, such as calcium hydroxylapatite (Radiesse), can be delivered to areas where skin laxity or deep tissue atrophy is worsening the appearance of acne scars. Calcium hydroxyapatite has been shown to improve rolling scars even after just one treatment.
Polynucleotides is a scientifically proven method of skin biostimulation, which regenerates the skin.
The first mechanism of action is stimulation of the fibroblast receptors in the skin, prompting their transformation into myofibroblasts. The process of type I collagen and elastin production is activated, which causes the skin to thicken and lift.
The second mechanism is the “scavenging” of free radicals and antioxidant activity.
Polynucleotides bind water and provide long-lasting hydration to the extracellular matrix. As a result, the skin becomes moisturized and supple.
Nucleofill Strong has higher concentration of Polynucleotides (2.5%) compared to other products in the market (only 2.0%)
Platelet Rich Plasma (PRP) injection
Platelet-rich plasma, or PRP, is a substance that’s thought to promote healing when injected. The idea is that injecting PRP into damaged tissues will stimulate your body to grow new, healthy cells and promote healing.
Plasma is the liquid portion of whole blood. It is composed largely of water and proteins, and it provides a medium for red blood cells, white blood cells and platelets to circulate through the body. Platelets, also called thrombocytes, are blood cells that cause blood clots and other necessary growth healing functions. Platelet activation plays a key role in the body’s natural healing process.
We are able to produce PRP by isolating plasma from blood and concentrating it. After blood is harvested, it is usually processed immediately in the clinic. Various systems are available for preparation of PRP, most of them consisting of a gel tube that can properly separate the PRP from the other blood components.
Be wary of certain providers who may just be using plain tube to prepare their PRP. These plain tubes are only meant for blood sample taking to be sent to pathology lab, and using these tubes to prepare PRP may cause adverse reactions, not to mention suboptimal results.
PRP has been shown to hold tremendous potential in the treatment of the following conditions
Plump up sagging skin
Get rid of deep creases
Improve one’s complexion
Diminish acne scars
Treatment of facial acne scars by using a picosecond laser with diffractive lens array has been shown to produce improvement to the appearance and skin texture comparable to that by a series of fractional ablative laser treatments. Histologic findings suggest that the improvement in scarring from this type of treatment goes beyond just remodeling of collagen.
Tissue histology reveals unique intra-epidermal cavities resulting from areas of laser‐induced optical breakdown (LIOB). This injury is most consistent with a localized plasma formation in the epidermis initiated by the melanin absorption of the high energy picosecond light.
The production of this LIOB directly stimulates an epidermal repair mechanism that results in improvements in pigment alterations and acne scars with the formation of new collagen, elastic tissue, and mucin.
Above: Before and after acne scar treatment at Dr Bob Clinic. Consent obtained for use of image. Photos are for reference only, individual results may vary.