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    Acne Treatment > Scar Treatment

Acne Scar Treatment

What are acne scars?

Acne scars are the result of inflammation within the dermis portion of the skin caused by acne. The scar is created by the wound trying to heal itself resulting in too much collagen in one spot. After an acne lesion has healed, it can leave a pinkish/reddish/brownish/blackish mark on the skin. This is actually not a scar, but rather a post-inflammatory change. The redness or blackening is seen as the skin goes through its healing course, which takes about 6-12 months. If no more acne lesions emerge on that area, the skin can heal normally. Any color change or skin defect still present after 1 year is considered to be a permanent defect or scar.

How is acne scar caused?

Scars result from a wound or injury. Scars are part of the skin's normal healing process. Generally, superficial wounds heal without scarring. It is when the dermis is damaged that scars form on the skin.Acne scars are most often the product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed blemishes occur when the follicle, or pore, becomes engorged with excess oil, dead skin cells, and bacteria. The pore swells, causing a break in the follicle wall. If the rupture occurs near the skin's surface, the lesion is usually minor and heals quickly. More serious lesions arise when there is a deep break in the follicle wall. The infected material spills out into the dermis, and destroys healthy skin tissue. To repair the damage done to the dermis, the skin forms new collagen fibers. Collagen is the fibrous protein that gives the skin its strength and flexibility. Unfortunately, the finished "repair job" never looks as smooth and flawless as before the injury.

As the wound heals, the body sometimes produces too much collagen, which creates a mass of raised tissue on the skin's surface. This type of scarring is called hypertrophic, or keloid, scarring.

More commonly, acne causes atrophic, or depressed, scars. Atrophic scars develop when there is a loss of tissue. Ice pick and boxcar scars are two examples of atrophic scars. Inflammation is the single greatest gauge of scar development. The greater the inflammation on the skin, the more likely scarring is to occur. Deep breakouts that take a long time to heal also increase the chance of scarring. Blackheads, whiteheads, and other non-inflamed blemishes typically don't cause scarring because these types of lesions don't injure skin tissue.

Can we prevent acne scars?

Best way to prevent acne scar, is to treat acne early and properly. Other than that a few simple measures may help:

  1. Use of effective sunscreens
  2. Using a topical medications  such as alpha hydroxyl acids and tretinoin under the advice of a dermatologist. This speeds up the skin's remodeling process and helps heal post-inflammatory changes.
  3. Picking at scabs should be avoided at all costs. Scabs form to guard the healing procedure that is going on below them. Pulling a scab off before it is ready hampers the healing and remodeling process which in turn lead to formation of scar.
What are the different types of acne scars?

There are several classifications of acne scars. To put it simply:

  1. Ice pick scars: Deep pits that are the most common and a classic sign of acne scarring.
  2. Box car scars: Angular scars that usually occur on the temple and cheeks, and can be either superficial or deep, these are similar to chickenpox scars.
  3. Rolling scars: Scars that give the skin a wave-like appearance.
  4. Hypertrophic scars: Thickened, or keloid scars.
How are these scars treated?

The treatment can vary depending on type of scar, and the treating dermatologist.
There are many procedures that can be used to correct acne scars. Each procedure has its own risks and benefits, and several procedures are normally combined to create the smoothest appearing skin.

Dermal Fillers
There are many types of dermal fillers that can be injected into acne scars to raise the surface of the skin and give a smoother look. Examples of dermal fillers are fat, bovine collagen, human collagen, hyaluronic acid derivatives, and polytheyl-methacrylate microspheres with collagen. The injection of these materials does not everlastingly correct acne scars, so further injections are required.

Punch Excision
This technique of surgically correcting acne scars is used on deep scars such as ice-pick and deep boxcar scars. This procedure uses a punch biopsy tool which is basically a round, sharp tool that comes in diameters ranging from 1.5 mm to 3.5 mm. The size of the tool is matched to the size of the scar to include the walls of the scar. Under local anesthesia the scar is excised with the punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable. If it is noticeable, it is more amenable now to resurfacing techniques.

Punch Excision and Punch Replacement
With this method the scar is excised with the punch tool as above. Instead of suturing the skin edges together, the defect is filled with a punch skin graft usually taken from behind the ear. With this procedure a color and texture difference may be noticeable, but a skin resurfacing technique can be used 4-6 weeks after the grafting to correct this difference.

Punch Elevation
This method of surgically correcting acne scars is used on deep boxcar scars that have sharp edges and normal appearing bases. The same punch tool as above is used to excise the base of the scar leaving the walls of the scar intact. The excised base is then elevated to the surface of the skin and attached with sutures, steri-strips, or skin glue called Dermabond. This method lessens the risk of color or texture differences as can be seen with graft replacement, and lessens the risk of producing a visible scar as can be seen when wound edges are sutured.

Subcutaneous Incision or Subcision
Subcutaneous incision, also known as Subcision, is used to break up the fibrous bands that cause rolling scars. Subcision is performed under local anesthesia by inserting a specially beveled needle under the skin so that it is parallel to the skin surface. Staying in the plane between the dermis and the subcutaneous tissue, the needle is gently advanced and retracted in a piston-like motion cutting the tethering bands. This procedure causes bruising which fades after about 1 week. The risks of subcision include bleeding and the formation of subcutaneous nodules. Bleeding can be controlled with proper use of anesthetics and bandaging, and the subcutaneous nodules can be treated with injection of corticosteroids into the nodule.

Laser Resurfacing
Laser resurfacing has become a popular treatment for many skin defects. The most popular laser type used for resurfacing of acne scars is the carbon dioxide (CO2) laser. Lasers work by essentially burning the top layers of skin to a specific depth. The skin then heals replacing the burned layers with newer appearing skin. Recently a new type of laser called fractional laser has become available at DISHA SKIN AND LASER INSTITITUTE and this is safer than conventional lasers.

What is Fractional laser Resurfacing?
Fractional Laser uses numerous microscopic Laser beams, which create tiny Laser "punctures" (each of about 0.05 mm in diameter) into the skin while leaving the untreated surrounding areas intact. The untreated tissue helps to accelerate the healing process and rejuvenate the skin by promoting microcirculation and new cell growth.
How is Fractional resurfacing done?

Fractional resurfacing is done for photoaged skin and deep acne scars. It is a well tolerated and safe procedure. Prior to the treatment an anaesthetic cream is applied which prevents any kind of pain associated with the procedure
The procedure itself takes approximately 5- 10 minutes and the laser probe is passed over the entire facial skin. During the procedure the eyes are covered with protective goggles.
Immediately after the procedure the skin appears red and slightly swollen. There will be numerous microscopic white dots that will form small scabs over 1-2 days. This will be appreciated as fine scales. The scabs disappear by the fourth day and the skin appears shinier and smoother by the 7th day.

What is the downtime after Fractional Carbon dioxide laser ?

Fractional skin rejuvenation involves using a lesser energy and is a form a superficial peel. This has a low downtime of approximately 2 days. This can be repeated every 3-4 weekly for  4-5 sessions to give a youthful , radiant and glowing skin Fractional skin resurfacing , which is used for scarring uses a higher energy and therefore can  have a downtime of upto 7 days. This is generally repeated every 1½ to 2 months.

What care needs to be taken after fractional laser?

Post laser patients are generally given topical antibiotic cream.

The patient is advised to strictly avoid sunexposure to prevent post inflammatory hyperpigmentation or darkening of the lased skin.

Also smoking and stress should be kept at minimum to allow better healing

What are the potential sideeffects of Carbon dioxide laser?
Sideeffects of fractional CO2 laser are few and rare. Potential side effects include pain, itching, redness and / or swelling for few days. In rare cases, some patients may experience scab formation, bruises, infection and temporary hypo or hyper-pigmentation. There is no restriction of daily activities after the treatment. However, it is advisable to apply more moisturizer and sun block to soothe the skin and stay away from excessive sun exposure during the recovery period.

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