With all the recent advances in medical technology, it can be overwhelming to know which treatments to choose to improve your acne scars. Acne scars remain common despite our best efforts to treat acne early and reduce the damage to the skin. Acne scar revision takes into account not only the acne scar type, grading, but also age, medical history, skin type and the body’s unique healing capacity. Scars do change as we age due to the inherent changes in the collagen and elastin matrix within the skin. The types of treatment used for planning for acne scar revision is highly customised and takes into account the above mentioned factors. In this article, we shall discuss the common ways to improve acne scars.
1. Generate Collagen
Activating more collagen to improve the appearance of acne scars is the most common and widely used method today. Scarring is often a disruption of the collagen and elastin matrix within the skin, resulting in an uneven skin tone and texture. We perceive the skin to be uneven during daily interactions and in photographs as the result of the loss of light reflectance on scarred skin. Collagen synthesis, breakdown and remodelling is a dynamic process that changes with age.
There are a variety of methods on how we can induce collagen. For mild scarring; superficial chemical peels, microdermabrasion and non-ablative lasers are suitable. In cases of moderate to severe acne scarring; deeper chemical peels such as TCA CROSS, subcision, dermabrasion, fractional ablative lasers (CO2, Erbium YAG) and micro needling fractional radio-frequency devices are available.
The resurfacing method for acne scars need to take into account the scar depth, scar type, scar grading and skin type. For example, individuals with a darker skin complexion have a higher risk of pigmentation if ablative lasers such as the CO2 lasers are considered. On the other hand, individuals with predominantly ice pick scars may be more suitable for TCA CROSS, rather than subcision and fractional resurfacing.
2. Amend Colour
The second most common request is to improve the colour of the acne scars. The change in colour may be the result of an over zealous inflammatory response within the skin. Colour changes are more common in Asian type skin, and are more noticeable to the observer. Post-acne scarring colour can be hyper pigmented (light to dark brown), vascular (pink to red) and rarely white (due to the loss of melanin).
The correct terminology includes:
- Post-inflammatory Hyperpigmentation (PIH) – Light to Dark Brown Colour
- Post-inflammatory Erythema (PIE) – Pink to Red Colour
- Hypopigmentation – White Colour
Treatment options for treating PIH depends on how deep the pigments are located within the skin. Lightening creams and sueprficial chemical peels can help with surface PIH, whereas pigment focus lasers such as the Q-switched Nd:YAG laser can target deeper pigmentation. For red acne marks or PIE, good skin care, intense pulsed light and vascular lasers such as the Pulsed Dye Lasers can reduce the blood vessel component in this form of scarring.
Acne scar that is due to a loss of volume can benefit from fillers. The loss of collagen in the dermal layer of the skin can cause a depression visible from the skin surface. Fillers come in a variety of materials. Natural fillers such as fat grafting involves a procedure to transfer fat from one place to another. The down side is a scar on the donor site, and longer downtime. Fillers also come in a variety of agents such as hyaluronic acid, collagen and polymethyl methacrylate (PMMA). The choice of fillers will depend on the size of the scar, the expected longevity of the results and the downtime involved.