Acne affects 85% of people between the ages of 12 – 24. There are various types of acne that range from simple black/white heads, papules/pustules, to the cystic breakouts. It’s the cystic acne that leads to most of the scarring. Acne scarring can have a impact on one’s appearance leading to a significant emotional toll. Lack of self esteem, social withdrawal, negative self image, and depression have all been described by acne scarring sufferers. Acne scarring questions are one of the most frequently asked questions to the experts on Realself.com. It’s important for the medical community to address this problem for the overall well being of a significant segment of the population.
It might seem obvious, but in order to treat acne scarring, the active acne must be controlled. It’s the author’s opinion that acne can be controlled with topical medications combined with lasers. A newer treatment, recently popularized by Dr. Weiner, has been the use of Botox/Dysport for controlling the sebum production in the skin. Please see my blog for more details about acne treatments.
Fresh Acne Scarring Treatment
When acne scarring is still red, treatment is easier and results are better. The primary treatment for scars in this stage is vascular lasers. It has been found that early scar formation can be reversed using these lasers over several sessions. The author’s choice of lasers is the Spectra Q Switched Laser – Gold Handpiece. This offers a quick (5 minute) nearly painless treatment. It should be done 4-6 times in general. Other laser options are the Excel V or the VBeam. Some small smoldering areas of acne are treated simultaneously with these lasers as well.
Long Standing/Persistent Scarring Treatment
Longer standing scars are harder to treat than early red scars. Collagen has been laid down in an inappropriate, disorganized manner. Treatments are directed at breaking up this collagen and for it to reorganize in a more natural manner. There are a few ways this can be done:
- Lasers: There are ablative (tissue is removed) and non ablative (tissue is heated) lasers. There is more downtime, more risk, and more results with the ablative lasers. Darker skin types are at risk for darkening of their pigmentation (hyperpigmentation)
- Subcision: Using a needle or similar, the physician goes under the scars and cuts them from their deeper attachments. This process has been used for decades and has minimal risk and downtime. It’s the authors opinion that unless something is placed in the area where scarring was cut, the scar will reform between the “sticky edges” as it does in all other surgical wounds. Bellafill is a permanent filler that was recently FDA approved for acne scars. Dr. Weiner suggests placement of Bellafill in these subcised scars to keep the edges from tacking back down, and to fill lost volume in the rolling acne scars.
- Microneedling Fractional (Controlled Depth) Radiofrequency: This technique uses RF energy to break up and reduce the scarring with coagulation. The healing process leads to a more organized collagen matrix. The best in class device for this category is the Infini from Lutronic. The insulated needles, variable depths, and fractional delivery make it extremely safe for all skin types with minimal downtime and risk.
- Platelet Rich Plasma (PRP): PRP has been shown to improve healing times and results in many areas of orthopedics. As of yet, there are no studies that definitively say that PRP can help acne scarring but there are several case reports that it improves outcomes. It is probably an effective addition to laser or RF procedures when treating acne scars with no known detrimental side effects.
Dr. Weiner Recommendations for Mature/Long Standing Acne Scars:
The most effective energy based treatment for acne scars seems to be the Infini. Results from ablative lasers (CO2), and non ablative lasers (Fraxel 1550) don’t seem to match the Infini’s results in his clinical experience. Patient satisfaction is higher with Infini, with much less downtime and a safety profile, particular in darker skin types, unmatched by the lasers.
For persistent defects after 3 or more treatments with the Infini, subcision with Bellafill administration is then recommended. It typically will take about 2 treatments, 2 months apart, to get optimal results with this method. This is only practical on about 10 – 15 lesions at a single session.
PRP can improve healing times and may improve results.
Remember that acne scars “won’t go away” but will be improved with the treatments mentioned.