dark skin Archives | The Aesthetic Clinique

Melanocytes are the cells responsible for the pigmentation in the skin. Their activity can be increased in response to inflammation. When skin becomes hyperpigmented from an injury, it is called “post inflammatory hyperpigmentation” or PIH. This is particularly prevalent in darker skin individuals, where there is more melanocytic activity, but can occur in lighter skin individuals as well.

The widely accepted scale for skin pigmentation types is the Fitzpatrick Scale. The Fitzpatrick Skin Type 1 are extremely light skinned, have blue eyes, and burn extremely rapidly with sun exposure. Type 6 individuals have very dark skin, dark eyes, and tolerate prolonged sun exposure without burning. In general, the type 4-6 skin types are the ones at risk for PIH.

PIH is possible after the following:

Laser procedures (mainly laser resurfacing)
Acne
Surgical incisions
Chemical peels
Burns
Infections
Radiofrequency (Infini is low risk)

The best way to treat PIH is prevention, if possible. Prevention consists of calming down the melanocyte metabolism. The standard recommendations are Retin A and hydroquinones. If there is a procedure a darker skin individual is planning that has risks of PIH, this regime should be started at 3 weeks prior to the procedure. It should be continued at least a month and up to 3 months afterwards. These 2 topicals are also standard therapy for patients with PIH.

Prolonged inflammation after a procedure (more than a week) in a darker skin individual, is a risk for PIH. The practitioner needs to recognize this and treat the inflammation appropriately. If there is prolonged redness of the skin, steroids and/or vascular lasers are needed to reduce this. If infection suspected, antibiotics are needed. Calming the skin is essential to prevent PIH.

The timing of PIH is very predictable. It almost always occurs about 3 weeks after a “at risk” procedure is performed.

If there is already PIH, treatments which can be used are:

Topicals such as Retin A, hydroquinone, and steroids; Triluma contains all 3
Chemical Peels
Gentle laser treatments with a 1064 laser (nanosecond or picosecond)
Possibly PRP with microneedling (experimental but minimal risk)
Antibiotics for ongoing infections
Laser hair removal for PIH associated with folliculitis

In general, PIH is best prevented then trying to treat after it occurs. Recognizing risk factors with certain procedures is the key to success. Treating prolonged redness is often overlooked and must be treated aggressively rather than taking a “wait and see” approach.

All of these answers were done before the Infini was invented. It might be the best option for acne scars currently.

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Q: Looking for a laser to remove post acne marks! (Photo)

A: PIH from acne can be treated with topicals usually.

PIH is treated in most cases with a combination of Retin A and skin lightening agent such as hydroquinone or Lytera from SkinMedica. This will also help prevent further acne. I you are looking for laser treatment, consider the Fraxel Dual, which can resurface the skin, helping with acne scars and pigmentation. Steve Weiner, MD, Facial Plastic Surgeon.

Q: What kind of treatment is suitable for these scars? plz help me i am totally confused

A: Fairly extensive acne scars can be helped with the Infini

Infini is a new RF device that uses microneedling with bipolar RF. It can go as deep as 3.5mm. There is no pigmentation risk as there are with lasers. You have to remember that it will take many procedures to improve (5-10) and it won’t get to look normal, just better. Other options are punching out the ice pick scars, Fraxel, subcision, CO2 laser.

Q: Please Help Me With My Acne/Severe Acne Scarring? (photo)

A: In a hispanic person, I believe that the Infini is best for acne scars

The Infini uses microneedling as well as radiofrequency. I will not cause hyperpigmentation as lasers can in you skin type. It would have to be done several times just like you would if you used the Fraxel laser. It goes deeper than the laser as well. It new to the US and we are lucky to be one of the first users of this device. Steve Weiner, MD, Facial Plastic Surgery, Destin, Florida.

Q: How Much Improvement Can I Hope for with Acne Scars of This Severity? (photo)

A: Very severe acne scarring. Needs lasers, fillers, maybe Infini RF

You present with very severe acne scarring. Improvement of 30% is a fair estimate. Multiple modalities are needed including: lasers-ablative or non ablative, filler for volume, RF Infini, and maybe subcision. It’s going to be a long program. Infini looks promising because in can go 3.5mm deep, and is safe for all skin types. Steve Weiner, MD, Destin, Florida.

Q: Do I Have Deep Acne Scarring or Light/medium Pitted Scars? What Are the Best Treatments for This? (photo)

A: Acne scars can be treated many ways: lasers, peels, fillers, RF devices

It hard to say what’s the best for you. There are a variety of options available, some more aggressive, some less. One new option is the Infini RF device from Lutronic which I think would do well with your skin type. Please see my blog which details several options. Steve Weiner, MD, Destin, Florida

Q: What is the Best Laser Treatment for Acne Scars on the Cheeks?

A: In my opinion, the Fraxel Dual 1550nm laser is best for acne scars of cheek

I feel that the Fraxel Dual 1550 lasers offer great improvement in acne scars and has a long history of being used for this. (Before the Dual, the Fraxel re:store was a 1550 laser as well). Others will argue that a fractional CO2 laser is better, but there is more pain, more risk, and more downtime. You can need 5-10 treatments, so don’t just stop at one. Also, your skin will never return to normal, just better, 35-60% better I would say. I’m looking at Lutronic’s Infini now as a possible treatment for acne scars. It’s been used worldwide for this problem and just got FDA approval in the states in July. This would be no downtime and no risk of hyperpigmentation in the darker skin individuals. It uses RF with microneedling. Please see my links for more information, Steve Weiner, MD, Facial Plastic Surgeon, Destin and Panama City, Florida.

Q: Can I Get Indented Acne Scars and Ruddiness Fixed? (photo)

A: Ruddy complexion is helped with VBeam and acne scars need various other treatments

Ruddy complexion is treated with the VBeam to decrease the redness. This is state of the art for this condition. Acne scars can be treated with: Fraxel 1550, filler, Ulthera, Inifini, fractional CO2, micro needling, or dermabrasion. You must discuss these options with your doctor. Each has its benefits, downtime, and risks.

Q: Treatments for Raised Scars on Nose? (photo)

A: For minor scarring of the nose, fractional CO2 or Fraxel re:store are good options

Remember that you will always have scars, they will look better though. To my eye, the scars look fairly minor and you might be expecting too much. The full results of the CO2 aren’t completely appreciated at this time. I can take up to 9 months. Periodic Fraxel is a good no downtime approach as well that you might consider.

Q: How to Get Rid of Acne Marks and Fix Discoloration?

A: Treating acne scarring – many options, please see attached blog

Treating acne scars can be done various ways. I have written a blog discussing the available treatments at my office: VBeam, Fraxel Dual, peels, topicals, TCA cross, Ulthera. It’s hard to say what is right for you. Don’t expect your skin to “go back to normal” though. Expect improvement. Options not discussed but may work as well are: subcision, microneedling. Steve Weiner, MD, Panama City, Florida.

Q: What is the Permanent Treatment of Mild Acne Scars?

A: Once acne scars are treated, they shouldn’t come back if no acne occurs.

I just wrote a nice blog about treating acne scars. Most people need the Fraxel 1550 to improve anything but very mild scars. Plan on up to 10 treatments and expect improvement, not resolution of the scars.

Q: I Have a Red Acne Scar Above my Upper Lip. How Can I Get Rid of It? (photo)

A: Red acne scar above lip best treated with VBeam

It appears you have active acne with acne scars. You are a perfect candidate for using the VBeam. It will help both the scars and future acne breakout. It will be about 3-4 treatments. The VBeam is state of the art to improve redness.

Q: I Can’t Tell How Bad my Acne Scarring Is? (photo)

A: Redness from acne is treated well with the VBeam

You seem to have active acne with some healing areas. The VBeam is a great treatment for this because it will treat both. When things settle down and the redness is gone but there is scarring, the Fraxel dual can be used for that.

It’s hard to assess the scarring from the pics because of all the redness currently. I encourage you to get the VBeam now. I’ve had great success with it and it will help prevent further scarring.

Q: Best Way to Get Rid of Post Acne Red Marks? (photo)

A: Best way to get rid of red marks from acne is the VBeam

The VBeam is perfectly suited to take care of anything red on the face. It’s great for this situation because it also helps with the acne. So you help with the redness and with acne, all in one treatment.

Q: Indented Depressed Scars on Nose That Looks Like Very Large Pores? (photo)

A: Indented scars on nose respond well to TCA Cross

I have found a relatively inexpensive with little risk procedure for this – TCA Cross. It uses highly concentrated TCA (a peel chemical) to induce the body to produce collagen to “fill” these areas. It takes about 4-6 treatments with very little downtime. I would try this first. It no results, try Fraxel 1550 laser.

Q: Acne Scar Removal (Dark Skinned Indian Male)? (photo)

A: Acne scarring in a dark skin person can be treated with Fraxel but at risk for hyperpigmentation

You have to set your expections that you could improve but resolve the scars. Your skin will never be free of scarring. Normally I would say about 40% improvement is what you can expect at best, but because in darker skin individuals, the Fraxel settings are more conservative, it would be less than that. Most likely, there will be some hyperpigmentation, but that is almost always reversible, and it is helped with prevention: hydroquinones pre and post procedure and sun protection. It takes a compliant patient with your skin condition for me to do this. NOW WE WOULD USE THE INIFINI

Q: How Can I Get Rid of Acne Red Marks in Less then 6 Months?

A: Red marks from acne are best treated with the VBeam for fast improvement

The VBeam is a great laser to improve redness from acne/early scarring. It is a fast and nearly painless procedure with little to no downtime. It might require 2-3 treatments. As a side benefit, it also helps with the acne.

Q: What is the Most Effective Way of Getting Rid of Red Marks from Pimples?

A: To get rid of redness from acne, use the VBeam – treats both acne and redness great

Many people have acne problems. Even after the acne improves, there is residual redness. Well the VBeam is perfect for this problem. The VBeam is the gold standard for treating redness, and it does a pretty good job at controlling acne as well. It’s a quick, safe, and almost painless laser. You might need to be treated 2-3 times to get the redness to your satisfaction level.

Q: How to Treat This Old Indented Scar? (photo)

A: Treating a depressed scar needs to have filler placed underneath and maybe laser after that

The picture shows that the majority of the problem is that there is loss of tissue volume in the area of the scar. I would first treat with a filler, either Restylane, Perlane, or Belotero. If you don’t have the results you want after that, and the volume is corrected, Fraxel Dual would be helpfull to correct the superficial scar tissue.

Q: Will This Scar Possibly Improve or Heal? (photo)

A: Depressed acne scar needs a “lift” with a filler like Restylane or Scluptra

Stop using the home remedies, you are just wasting money. It appears that the scar is depressed and you need some volume underneath it. Restylane is probably my first choice for this, but if desiring a longer fill, sculptra might work well too. There still might be a superficial scar after the filler, and this could be treated with the Fraxel Dual, 1550 laser. Don’t expect to completely resolve the scar, but it should look better.

Q: Acne Scarring-Silicone or Other Treatments? (photo)

A: Acne scarring Treatments

By the looks of your scarring, it seems to be fairly extensive. I would recommend either fractional CO2 or Fraxel 1550. Your skin unfortunately will never return to it original texture, but I have seen dramatic improvements with these lasers. I will take multiple treatments. I would not do silicone. In the future, LaViv, might be a good option, the studies are being conducted now. Stem cells might also help, but that is not investigated too well at the present time.

Q: Can Acne Scars Be Removed Completely?

A: Acne scars can be improved but not removed.

There are several methods to improved acne scars: peels, laser resurfacing, punch excision, subcision, filler. All of these are helpful but none will completely resolve the problem. For people with extensive scarring, the only real viable option is the laser. In my opinion, Fraxel re:pair or Fraxel Dual, are very good at improving scarring.

Q: Fraxel / TCA Treatments for Acne Scarring – Scheduling Question

A: Acne scarring requires multiple Fraxel Dual Treatments, less if doing Fraxel re:pair

I don’t think there is any data on the combo of TCA and Fraxel. I’ve done it frrequently, but usually I do several TCA Cross treatments before the Fraxel. If you are doing the Fraxel re:store or Dual, you will need much more than 2 treatments. I would look at 4 or 5. Fraxel re:pair probably 2 is adequate. One of my biggest issues with patients is that they want to know up front how many treatments are needed. This is very difficult to say and you have to be very flexible as to how many you will need. Keep in mind that erasing acne scars is not going to happen. They are going to look better, but not usually completely gone.

Q: Removing Hyperpigmentation Spots, Craters & Oversized Pores

A: Fraxel Dual would be good for Hispanic Skin with acne scars and enlarged pores

I feel that the Fraxel Dual is your best option for improving the acne scars and enlarged pores. I can’t be done until you are off Accutane for at least 6 months. The Fraxel treatment will also help your acne. Instead of Accutane, you could consider Levulan with Blu U activation. 2 or 3 or these can greatly improve your acne without the side effects or risks associated with Accutane.

Q: Best Laser Treatment for Acne Scars on Brown Skin?

A: Fraxel re:store Dual would be best for acne scars on Indian skin

I think that the Fraxel re:store Dual would be best for your skin type for acne scars. There are certain precautions that are needed. You need to use hydroquinone at least 4% for about 1 month prior. Sun exposure must be limited for 6 weeks prior and a couple months after.

Gentlewaves treatment has been shown in clinical papers to decrease hyperpigmentation risk. I would restart the hydroquinone about day 4 or 5 after treatment. I would avoid the highest settings on the laser and would not do treatments any closer than 6 weeks.

You can consider Retin A about 2 months prior to treatment and stopping 1 week prior. Restarting it about a week afterwards. Another option is the Fraxel re:pair. The result will probably be better, but you will need about 2, maybe 3 and there is wound care and downtime. Your risk of hyperpigmentation is greater with the re:pair, but almost always, this is temporary. Hope this helps.

Q: Best Options for Hypopigmented Acne Scar?

A: Hypopigmentation is tough to fix, but improves with Fraxel re:store or re:pair

Until fractional laser, there wasn’t any real good treatment for hypopigmentation. Nowadays, fractional lasers like the Fraxel re:store or Fraxel re:pair offer some hope. I have personal experience with the re:pair and the Lux 1540. Both have shown improvements in hypopigmented scars. Temper your expectations. It won’t be eliminated, just improved.

Q: What Exactly is Done During Punch Excision for Acne Scars?

A: Punch excision of icepick scars uses a circular scalpel

This technique uses the same instrument as a punch biopsy. You numb the skin with a small injection of lidocaine. You then twist a circular blade thru the area around the scar. The middle portion is then pulled up and cut out, leaving a small hole where the scar was. The hole is then closed with a suture. Multiple areas can be done, and there is no limit as to how many can be done. Occasionally, a small laser treatment after the area is healed is needed for the best results.

Q: Best Acne Scar Treatment for Asian Skin?

A: TCA Cross is good for acne scars

This technique involves placement of very concentrated TCA on the scars. There is minimal downtime. It needs to be repeated several times. There were initial studies done on Koreans with no adverse skin reactions so I feel it’s safe for you. After the wedding, the Fraxel re:pair is very good for acne scars. I have done several asian skin types without adverse reactions. You need to be on hydroquinones before and after the procedure.

Q: Nashville Acne Scar Treatment Doctor?

A: Dr. Brian Biesman

Dr. Biesman is past president of the ASLMS (American Society of Laser Medicine and Surgery). He is a wizard with lasers. He has tried them all, and is asked by the laser companies to trial the up and coming lasers. Without hesitation, please call him.

Treating Post Inflammatory Hyperpigmentation (PIH)

Acne Scar questions answered by Dr. Steve Weiner, Facial Plastic Surgeon

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