Acne Scars - The Treatment Options
Graphic: i-Stock
Acne scars are such a common presentation in many aesthetic clinics. It can range from mild and slightly darkened scar from a recent breakout, to more severe acne scars with pits and uneven skin surface similar to that of the moon surface. Whatever form it takes, acne scars can adversely affect the confidence of the afflicted person.
Graphic: Google
Mild acne scars with slight darkening (above) is common, especially from a recent breakout. Lightening cream is an option to reduce the pigmentation. However, the best treatment for this sort of scars is prevention of acne itself, early treatment of acne breakouts and also resistance from the urge to pick at acne spots during breakouts.
The choice of anti-acne products are important and you may not necessarily have to break the bank to purchse expensive sets of products. A combination of a foaming, deep-cleaning facial cleanser (recommended for use 2-3 times a week), combined with a daily use of a mild cleanser should do the trick for most of us, who may have combined oily-normal skin types. The oil-busting cleanser that can be drying to the skin, is balanced with a mild cleanser that retains most of the skin’s natural moisture - I often prescribe Obagi Foaming Cleanser, coupled with Therapeutic Dermatologic Formula (TDF) Mild Cleanser.
The frequency of the deep-cleansing foaming cleanser is adjusted by the user according the dryness of the skin - if the skin is too dry, reduce the frequency to 1-2 times per week. In addition, the foaming cleanser should be used in a reasonable amount, lathered on the palm till it foams and then applied to the face beginning from the oiliest part of the face.
Next, moisturisers play an important role in the retention of skin moisture and maintenance of good skin barrier function. For our rather humid Singaporean climate, I often recommend a light, hyaluronic acid (HA) based serum moisturiser. It is highly absorbed by the skin, very light in texture and most importantly, it does not clog our pores (non-comedogenic). The Misojium Undiluted HA Ampoule comes to mind when I talk about this - it is inexpensive, hypoallergenic and suitable for all skin types.
Graphic: Dr Chris Looi
Acne scars can come in 3 common forms - box-car scars, ice-pick scars and rolling scars (see above and below). The common cause of these scars is untreated, severe acne that has lead to permanent scarring of the affected surface. And most often, the skin in that area can become atrophic - ie lost of skin turgor and loose.
Graphic: Google
The gold standard of acne scar resurfacing is with the CO2 fractional laser. It is a powerful laser that vaporises the surface of the skin while coagulating the underlying tissues resulting in diminished depth of acne scars. The advantage of this treatment that is is very strong hence requiring less treatment sessions, but the downside is the risk of post-inflammatory hyperpigmentation (PIH) and long downtime with brown coloured scabbing (below) of 5 to 7 days, sometimes more.
Graphic: Google
There are other less powerful lasers such as Erbium Glass lasers - they are more gentle and produce less collateral damage to the skin. The downsides are more sessions required and being a laser, the high risk of PIH is still there.
More up-to-date, non-laser resurfacing procedures such as the VenusViva NanoFractional Radio Frequency (RF) or IntraCell RF Needling have become more popular in the recent years due to their non-laser nature (hence lower risk of PIH). IntraCell RF Needling requires puncturing of the skin by the device needle to allow deep scar treatment. The needling itself does carry the downside of more discomfort and longer downtime.
Graphic: Venus Concepts, Inc.
VenusViva NanoFractional Radio Frequency (RF) has gained popularity in the recent couple of years due to the colour-blind nature (hence lower risk of PIH), lower downtime (3-4 days) and much less collateral damage to surrounding healthy tissues (see above). Due to the nature of radio frequency (RF), it allows the doctor the adjustability of the ablative power to reduce scar depth and coagulative power to tighten wider scars. Shorter downtime is highly desirable for those who cannot afford downtime longer than a weekend.
Rolling scars may require needle subscision - breaking up the fibrotic scar underneath the skin. And in some cases, the doctor may offer chemical peels (such as TCA-Cross peel) or dermal filler to further diminish certain acne scars.
The options available for acne scar treatment is numerous in the market. The choice of treatment method depends on the severity and the downtime. The cost of acne scar resurfacing is inexpensive and many clinics offer decent prices. Hence, the deciding factor is the trust you that have in the doctor performing the procedure.
Disclaimer: The opinions expressed here are solely my own. It does not replace a consultation with your doctor.