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The treatment of Acne Scarring should be deferred until all active acne has been eradicated and there are no more major outbreaks.
As a cosmetic clinic that regularly witnesses the self-consciousness, despair and psychological devastation that acne scarring inflicts on patients, it is unfortunate that the prescribing of a retinoid-derivative drug (Government regulations prevent us from mentioning it by name) – regarded as the ONLY REAL CURE FOR SEVERE OR REFRACTORY ACNE – is not made available to General Practitioners who are the very doctors whom acne sufferers usually first consult.
We believe that if General Practitioners were allowed to prescribe this drug for severe forms of acne before any acne scars developed, the incidence of Acne Scarring would dramatically decrease!
Although Acne Scars in most cases cannot be totally eliminated there are a number of procedures available that can considerably lessen their appearance and make them much less noticeable.
Essentially, your skin type as well as the shape and depth of your acne scars will determine which treatment or combination of treatments is best for you. As most people have a variety of scar shapes and depths, more than one type of treatment may be necessary for the best possible result.
At your Initial Consultation, our Doctor will carefully assess your skin and the shapes of your scars and then explain which treatment, or combinations of treatments, is best for you.
Treatment options for acne scarring include:
- Medical Micro-Dermabrasion to reduce the appearance of the scarring. Micro-Dermabrasion does not significantly reduce the depth of the scars, it more changes the light-reflective properties of the skin and thereby the scars may appear less conspicuous. Micro-Dermabrasion is NOT the same as the old technique of Surgical Dermabrasion that was used for acne scarring and had the unsightly side-effect of loss of skin colour. Surgical Dermabrasion has long since been replaced by the more controlled and safer Laser Skin Resurfacing (see below).
- Collagen Induction Therapy, or simply ‘CIT’ for short, is a treatment advocated especially for people with coloured skin by Dr Des Fernandes, Plastic Surgeon, in Cape Town, South Africa. CIT aims to stimulate collagen synthesis and thereby improve the appearance of the scars. One advantage of CIT is that, unlike Laser Skin Resurfacing, it can be used on those with brown, olive or Asian skin without the risk of pigmentation complications.
- Dermal Fillers to fill out the scars is one of our most frequent recommendations for specific shapes of acne scarring. It is the best option for ‘valley’ shape acne scars which are less responsive to the other treatment options such as laser resurfacing. Essentially, using a very fine needle, enough Dermal Filler is injected beneath each ‘valley’ scar to bring it up to the level of the surrounding skin surface. There are currently on the Australian market a number of dermal fillers which have the ability to improve the appearance of specific shapes of acne scars by filling them out.
- Our doctor will give you a choice of suitable Dermal Fillers at your initial consultation.
- Surgical Excision of the scars is an option for those scars that are not suitable for other treatments. The methods include simple excision, punch excision and punch grafting. They can be easily performed under local anaesthesia. However, be mindful that surgical excision will always leave a surgical scar, and so consideration needs to be given as to which of the two scars – the acne scar or the surgical scar – will be the least obvious.
- Laser Skin Resurfacing is one of our most frequently-performed treatment options for acne scarring. It delivers its best results with the shallow acne ‘pits’ and shallow ‘crater’ types of acne scars. It is not very effective for ‘valley’ scars. Laser Skin Resurfacing is performed in our own Clinic’s Operating Theatre under Local Anaesthesia with/without Sedation administered by our Specialist Anaesthetist. You can go home immediately after but you must be escorted home if you have had sedation. Laser Skin Resurfacing requires 9 days’ downtime following which you will return to the Clinic to be checked and be prescribed a cream to settle the normal and mild post-operative redness.
- At the Sydney Cosmetic Clinic, we use the latest computerised Fraxel Repair CO2 Laser for the treatment of acne scarring. Being a Fractional CO2 Laser, it removes only tiny columns of skin leaving intact skin in between to aid in the healing process, shorten recovery times and reduce the chances of hypopigmentation (loss of skin pigment).
- However, the laser cannot remove scars that reach deeper than the laser can reach. Realistically, therefore, you must not expect that every acne scar will disappear. Instead, you should only expect a reduction in the number and depth of the scars.
- PLEASE NOTE: Laser Skin Resurfacing is not suitable for those with olive, brown or Asian skin because of the risk of causing pigmentation complications.
- Also, if you have been taking Roaccutane for acne, you must wait for at least 12 months after finishing it before having any Laser Skin Resurfacing.
NB: Chemical Peeling, although excellent for other skin conditions, is generally not useful for acne scarring unless the scarring is very fine.
Types of acne scars & their treatments
Essentially, the shape and depth of your scars as well as your skin type will determine which treatment, or combination of treatments, is best for you.
‘Rolling’ or ‘ Valley’ Scars are difficult to remove with any form of skin resurfacing such as Chemical Peeling or Laser Skin Resurfacing. We find that dermal fillers to raise the depressions to the level of the surrounding skin surface are often the best option for this type of scar.
‘Ice-Pick’ Scars are small, deep pitted scars. Punch excision is usually the best option to remove these unless they are very shallow in which case Laser Skin Resurfacing could be a worthwhile option.
‘Boxcar’ or ‘Crater’ Scars if shallow may respond well to Laser Skin Resurfacing otherwise Dermal Fillers to raise them to the level of the surrounding skin surface would be the best option.
‘Hypertrophic (Raised) Scars’ respond best to surgical excision or Laser Skin Resurfacing.
As most acne scar sufferers have a variety of scar types, more than one type of treatment is usually necessary.
At your initial consultation, our Doctor will carefully assess both your skin and your scars and then outline which treatment or combination of treatments is best for you.
Click on images to enlarge
Acne Scarring BEFORE & AFTER Fraxel Repair Laser Resurfacing