Acne scarring is a very prevalent problem in our society. It also a very common concern for clients in our office because it most often affects the face and becomes a cosmetic concern. Treatment options are based of the severity of the disease and the intensity/aggressiveness the client desires. One must accept the fact that scarred skin will never improve 100%. However, once a scar in improved, it should persist indefinitely, unless further acne causes more scarring.
UPDATE: We now offer Infini, a radiofrequency microneedling device. This appears to be a great alternative to laser for acne scars. Please read the link.
Topical treatments are needed for all cases acne scarring. The regime should include: Retin A or Retinoid, serum with growth factors (TNS Essential Serum or Lifeline), and sunscreen.
Early scarring, which is the result of recent acne can be treated best with the VBeam. The VBeam will help with the redness and hopefully slow or prevent the progression of the scar turning into a mature and firm scar. The VBeam also helps with future acne breakouts.
Ice pick scarring can be treated with punch excision which involves removing the scar in a sleeve like fashion and closing the skin with a stitch. The more preferred way at our office is to use high concentration TCA and to chemically burn each individual scar in a series of 4 or 5 treatments. This method is called TCA Cross technique.
For more severe global acne scarring, the Fraxel Dual 1550 nonablative laser is probably the gold standard. This laser has more studies and experience treating acne scarring than any other laser. There is some mild swelling for a few days but no open wounds to dress. Peeling occurs for a few days a well. The number of treatments varies according to severity of disease and desired effect, but could be up to 10 treatments. It is safe for all skin types. Ablative erbium or CO2 lasers are used for acne scarring as well but we don’t have these lasers in our office. It’s been our experience that patient’s prefer the less invasive lasers with less wound care. less risk, and downtime.
For minimally depressed scars, using dermal fillers like Restylane can be a quick and easy medium term (9-12 months) improvement. Artefill has just published a study and will probably get FDA approval for acne scars in the near future.
There is research being done for using Ulthera, LaViv, and stem cells for acne scars as this blog is being written.
In general, there are several different choices to treat acne scars. Lasers are required for the most severe cases. Treating acne aggressively to prevent scarring is obviously highly recommended because treating the scarring is much more difficult.