Acne Scars Treatment
Several methods have been developed for acne scars treatment over the years. They range from surgery, to lasers to injections. This article gives a brief about the various methods that are being used by surgeons and dermatologists to remove a source of concern for many.
The different methods used in acne scars treatment are:
Surgery – excision, subcision and punch techniques;
Abrasion – dermabraison and microdermabraison;
Laser resurfacing – ablative lasers, non-ablative lasers, pulsed dye lasers and fractionated lasers;
Chemical peels – surface layer peels, medium depth peels, deep level peels;
Fillers – collagen, saline;
They are explained below.
I) Surgery – This involves cutting away the scar to expose the underlying skin layer. When the exposed bottom of the scar heals, it gains a color close to that of the surrounding skin. Various types of surgical methods are used.
1. Punch excision – This method is used for deep lying scars like boxcar scars and ice pick scars. The tool used is a round shaped cookie cutter which can be varied in size to match the diameter of the scar. Once the tool is adjusted for best possible match the surface of the scar and its walls are excised. The open wound is then stitched to seal it. If the scar does not go away completely then the surface is reshaped using laser resurfacing method.
2. Punch elevation – This method is used in scars that have steep edges. The base is scraped off and lifted up to the level of the surrounding skin. It is then sutured with the walls. This reduces the chances of residual visible scar after the surgery. This also reduces the chance of spots of color difference between the scarred region and its surroundings.
3. Punch excision followed by skin grafting – The base of the scar is removed. The cut away area is replaced by skin taken from another area. The fresh skin is grafted into the area left vacant by the scar excision. After healing there is a residual scar that can be dissolved by skin-resurfacing techniques.
4. Subcutaneous excision – This method is used in removing rolling scars that contain fibrous bands. It is also known as subcision. A special type of bevel needle is inserted just below the surface of the scar to sever the tethering fibrous bands. This destroys the scar internally but the procedure also creates a wound which can get infected. Hence precaution is necessary following the surgery.
Acne Scars Treatment
II) Abrasion – This process involves filing off the surface of the scar with abrasives. The abrasives and the filed skin are sucked up through a vacuum pump. This improves the appearance of the skin.
1. Dermabraison – This method is used on shallow scars to cut away the surface layer and allow the healing process to bring a tone that resembles the surrounding skin. Often, when deep scars have been treated with excision technique, the residual scar is finished off with dermabraison. The patient is asked to protect his skin from sunlight for a few days following the surgery.
2. Microdermabraison – This is a finer technique and is used in minor shallow scars. A fine layer of the surface of the scar is sanded with abrasives. This gives a polished appearance to the skin. It can be combined with other peeling techniques for optimum effect.
III) Laser resurfacing – Lasers created using various types of diodes are used to burn away the surface layer of the scar. This method has also become a popular acne scars treatment method as the skin can be burned to a predetermined depth and allowed to heal. The healed skin resembles the surrounding skin closely. Several types of lasers are used.
1. Ablative laser – This is the most powerful laser used for re-surfacing. It uses carbon dioxide gas to create the laser. The other type of ablative laser used is Er:YAG or Erbium YAG laser. The CO2 is used in boxcar and ice pick scars which are deep scars. It burns off a deep layer of the skin hence the site must be protected after the surgery from sunlight and infection. The many side effects of this method are infection of the wound, discoloration or dyspigmentation and a hypertrophic scar. The burnt area can become white with permanent loss of pigmentation. Hence this method is not used on dark skinned people. This can also start acne, erytherma (red skin rashes) and edema (hydropsy, collection of fluid in the skin which makes it less elastic).
2. Non ablative laser – This laser method is used for shallow scars. It does not burn the surface of the scar but causes buildup of collagen just below the surface. There are fewer side effects from this method and the recovery time is short. However it cannot be used on moderate to deep scars.
3. Fractionated lasers – This laser is an advanced one as it does not cause pain. It acts on the water in the skin below the surface. The procedure can be completed quickly and within a few sessions. The only possible side effect is redness of the skin which lasts for a few days only. This is a non ablative laser.
4. Pulsed dye laser – This laser is primarily used in the treatment of acne. There are a few side effects. The number of sessions vary according to the severity of the acne.
IV) Chemical peels – This method involves peeling away the surface of the scar with abrasive chemicals. It can be done in three ways.
1. Superficial peeling – This is the quickest method of chemical peel and is carried out as an out patient procedure. This works only on shallow scars and the recovery period is short.
2. Moderate peeling – This is a moderate level of peeling and is used on moderate level scars. The peeling is slightly deeper than superficial scars hence about a week is required in healing.
3. Deep peeling – This method burns off the skin to a greater depth hence the recovery period can stretch to two weeks. This method is used on deeper scars as it is stronger. It is not used on people with dark skin as the skin will look lighter after the chemical peeling.
V) Fillers – This method works only temporarily and is one of the easiest acne scars treatment methods. Filler materials are injected in the scar tissue to make it appear smooth. The fillers can be collagen either the patient’s own or bovine collagen; saline injections, polytheyl-methacrylate microspheres mixed with collagen and derivatives of hyaluronic acid. The filler stretches the skin to make it appear smooth. Fillers need to be injected repeated and regularly over a period to maintain the look. Alternatively, a filler substance like saline can be injected and left in place in a balloon to allow the skin to stretch. When the skin has stretched enough, the scar is cut away and the stretched skin is sutured with the other end for a better appearance. The procedure can be finished either by laser resurfacing or through chemical peeling.
These are the methods used in acne scars treatment. To achieve the best results, surgeons may combine several of them. No single method can give the desired result in a single session and require a repetition for better results.