A discussion of acne scars should begin with the fact that they are very difficult to treat. Acne scars are difficult to treat because the defect is usually located deep within the dermis. A treatment method can only be successful if it reaches a depth equal to or greater than the depth of the scar being targeted. Even the best acne treatment methods fail to achieve 100% improvement. There is no such thing as “perfection” in this area of dermatology, but moderate and in some cases, excellent improvement can be achieved. Also, before we begin acne scar treatment we need to handle any active acne with comprehensive medical acne treatment to treat the root of the issue, which sometimes involved oral medication like Accutane treatment.
Patients are often given unrealistic expectations and how well you will do depends on what type of acne scars you have. If you live in or around the Hollywood, FL area, call Minars Dermatology today to schedule your consultation.
It is preferable to reserve the term “scar” for something that is permanent unless treated. An acne “scar” is a change in the texture or contour of the skin left by an acne lesion. It is something that you can feel with your eyes closed. A “blemish” is simply a change in color of the skin and you cannot feel it with your eyes closed. Acne “blemishes” are red or brown discolorations of the skin. These generally fade over time without treatment and are not considered true scars. Topical bleaching cream can be used to speed up the fading of the brown discoloration. And a pulsed-dye laser or an IPL can do the same for the red discoloration.
Acne scarring can be divided into 4 basic types*: icepick scars, rolling scars, hypertrophic scars, and boxcar scars.
Icepick scars are narrow (<2mm) and deep. Their name derives from their appearance: the skin looks as if it were stabbed with an icepick.
Rolling scars are those shallow wide scars with a gentle slope. They have a rolling or undulating appearance.
Hypertrophic scars are raised acne scars. They have a firm, rubbery feel to them. Injections with cortisone and some of the lasers mentioned below may help to flatten these scars.
Boxcar scars are round to oval or sometimes rectangular depressions with sharply demarcated vertical edges. They are more “punched out” appearing than rolling scars and very much resemble chicken pock scars. They may be shallow or deep and are most often 1.5 to 4.0 mm in diameter. Shallow boxcar scars may respond to a resurfacing laser such as the Fraxel laser, while deep boxcar scars must be cut out and sutured.
As mentioned above, fading acne scars is extremely difficult and not everyone who undergoes treatment will have their scars faded completely. It is best to start with a consultation with an experienced dermatologist to determine if acne scar treatment is right for you.
Microdermabrasion is essentially a superficial skin peel. A machine uses little crystals to sandblast and buff the skin. Skin looks great after a microdermabrasion treatment. It is brighter and feels smoother. Microdermabrasion is an excellent skin treatment for patients with certain types of acne or pigmentation, but it is too superficial to make a real difference in your acne scars.
A punch excision is simply cutting out a scar and suturing the skin back together. It is useful for the treatment of ice pick scars or deep boxcar scars, as these do not respond to other treatments because of their depth. A “punch” excision uses a punch biopsy which is a round scalpel that is similar to a tiny cookie cutter. The result is usually a small line that replaces the hole of the acne scar. Hopefully the line will fade with time, however acne scarred skin often does not heal as well as normal skin and at times the skin does not stay together when the sutures are removed. It is wise to pick one or two test scars to try this technique and see how your skin heals before doing several.
Focal peeling involves the use of very high concentrations of trichloroacetic acid. These high concentrations are necessary to achieve the depth of treatment needed to affect boxcar or icepick acne scars, however it would be dangerous to peel someone’s entire face with these strong concentrations of acid. A toothpick-like applicator is used to apply the acid to one scar at a time. The acid destroys that scar, but all of the skin around it is left unaffected and therefore the treated area is able to heal from the outside in. Treatments are spaced one month apart and a scar may require 3 to 6 treatments.
Subcision is a simple surgical procedure used to treat rolling acne scars. Rolling scars are depressions in the skin that occur when the overlying skin is bound down or tethered to the underlying tissue. Subcision uses a needle that is inserted under the skin to cut the septa and release the skin. Typically, 2 to 6 sessions are required with a minimum interval of 1 month between each procedure. (We do not offer this treatment).
Laser resurfacing is basically a deep laser peel. Either an erbium or CO2 laser is used to ablate the skin on the entire face to a depth necessary to effectively treat the acne scars. This procedure is like an operation and is usually performed in an operating room under general anesthesia. The recovery often lasts two weeks, and carries a risk of infection and scarring. We do not perform erbium nor CO2 laser resurfacing because we do not feel that the benefit of this procedure justifies the risk. And now (for the last two years) we have an alternative that is safe and gives comparable results: fractional resurfacing (using the Fraxel laser).
Over the last two years, the Fraxel laser has become the “gold standard” for acne laser treatment. Not all acne scars will respond well to this laser. The Fraxel can significantly improve rolling or shallow boxcar acne scars, or in general, scars that are wider than they are deep. On the other hand it seems to do little for “ice-pick” scars.
One main difference is hyperpigmentation. Anyone with dark skin can tell you that EVERYTHING leaves a mark. Mosquito bites, scratches, ingrown hairs, and of course, acne, leaves brown spots. These brown spots are called “post-inflammatory hyperpigmentation” and if left untreated, they can take six months or more to fade.
The main differences when treating acne in black skin are: 1 – Our treatments must address both the acne and the hyperpigmentation that comes with it (we usually do this with a compounded bleaching cream and salicylic acid peels). And 2 – We must treat the acne more aggressively because even one pimple will leave a brown spot that lasts six months or more.
Bleaching creams can help treat acne scars on dark skin. Bleaching creams come in many varieties, but only the strong ones work. The most common ingredient in bleaching cream is hydroquinone. Over-the-counter bleaching creams contain only 2% hydroquinone and are not very useful or effective. Because we are dark skin acne scar treatment specialists, we still practice the rare art of “compounding” prescription creams. (“Compounding” simply means “mixing” several ingredients into a combination specific for each individual patient.) Actually, a specialty pharmacy does the “compounding” of the bleaching cream, we just tell them what to put in it.
Bleaching creams don’t actually “bleach” your skin like Clorox bleaches clothes. Instead, bleaching cream fades your dark spots and gradually evens out your skin tone and color. The one we prescribe for you, will also include an acne-fighting ingredient.
Even mild acne in dark skin must be treated aggressively. Again this is due to hyperpigmentation. When you have dark skin, you cannot afford to have even just a few pimples each month, because each one can leave you with a “souvenir” dark spot that will last 6 months to 1 year. And that is unacceptable.
If you have dark skin, acne, and hyperpigmentation, then we will start with aggressive therapy immediately. This might mean a acne scar cream and a pill, along with chemical peels. If results don’t soon follow, then we will quickly move on to even stronger treatments. And if nothing else works, or if the acne is severe or leaves scars, we always have Accutane (which works every time!).
All of our doctors have the expertise and extensive experience in treating dark skin for scene scars, dark spot, hyperpigmentation, laser hair removal for dark skin. and much more. It is a large part of our practice, and we are very proud of our expertise in this very specialized area of dermatology for dark skin.
“Dr. Vivas was a life saver for my daughter Ashley, she got acne in 10th grade, we tried everything and didn’t work. Dr. Vivas was so kind and knew exactly what she needed, managed to clear her acne and today my daughter has porcelain skin w no scars. Thank you!”
If you’re concerned with the appearance of your acne scars and live in the Hollywood, FL area, contact us today for a consultation. We always recommend consulting with a professional before beginning any type of acne scar treatment.
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