In our practice, one of the most frequent inquiries we receive is from clients who are desperate to diminish their acne scars. Some of our clients have had these scars from adolescence, and once we’ve treated and restored their skin, they feel a tremendous sense of relief and boost in their self-confidence. They not only look better, but it’s obvious they feel much better, too.
Essentially, all acne pitting treatments call upon the body’s wound healing response: the damaged skin cells are removed to encourage the body to create new, healthy skin cells in its place. This is done by lasers or physically stimulating by microneedles. Skin that is relatively smooth and only discolored by acne scarring is best resolved by a non-wounding, light-based treatment such as Broad Band Light (BBL), or chemical peels.
BBL treatments use heat via a flash lamp to produce light energy of multiple simultaneous wavelengths to minimize skin discoloration. BBL cannot make major improvements in the texture of skin, however, BBL can penetrate deeply through the layers of skin without ablating or wounding skin cells to improve discoloration. It interacts with the abnormally-colored target, heating it up. The hemoglobin within the discolored acne marks are warmed, healing the vessels and resolving the redness.
Another treatment long used in modern aesthetic medicine to help with discoloration are chemical peels. Chemical peels consist of a solution applied to the skin, which over several days gradually peels away thin layers revealing the fresher, healthy skin beneath. Chemical peels can generally be grouped into three categories depending on how deep they penetrate the epidermis: light (or superficial), moderate, and deep.
Perhaps the most common and gentle peel is the Alpha Hydroxy Acid (AHA) peel, which is derived from natural plant extracts. Other light peels with low downtime include lactic acid peels and the AHA-based glycolic acid and citric acid peels. The strength of these peels determine how deep they will penetrate and hence how much peeling will occur. The strengths are based on the percent of the acid we are using, for example a 5% glycolic peel is much gentler than a 15% peel. A series of these light peels may address the discolored acne scarring, however a stronger type of peel is needed for pitted scarring. Stronger chemical peels such as TriChloroacetic Acid (TCA) peel or a Jessner’s Peel – a precise blend of three different peeling agents: salicylic acid (derived from aspirin), lactic acid, and resorcinol, a petrochemical – are best suited for deeper acne scarring but will have a longer peeling time period.
Laser peels are considered a cosmetic surgical procedure and are performed by me or my physician assistant. These peels are best suited for those clients who prefer fewer treatments and a single recovery period.
Laser skin resurfacing removes the damaged topmost layers of the skin layer by layer and stimulates the production of collagen and new skin cells. The high energy, amplified light waves of carbon dioxide (CO2) laser vaporize the epidermis instantly, with no minimal bleeding and minimal trauma to the surrounding skin.
Instead of removing the whole skin as a flat surface, fractional lasers create hundreds of channels smaller than the size of pin holes in the skin. The body’s wound healing response is still activated, but because between the channels, some skin is left untouched, recovery time is much quicker, usually about 5 to 7 days.
Microneedling can be understood as the manual version of fractional skin resurfacing. The skin is punctured with micro-fine needles to create channels deep into the dermis that stimulate the body’s wound healing response and kick-start new collagen production. Microneedling can be performed on the entire face, or limited to the areas of concern. The micro-channels created act as a conduit for serums to penetrate deeper into the skin. These micro-channels close up fairly quickly after the treatment and patients leave the office looking flushed. There is very little downtime. Usually a series of these treatments are needed to achieve desired results.
Depending on the depth and severity of acne scarring, a complete treatment regimen can take anywhere from two to six sessions. Initial results can be seen in less than a week with full collagen remodeling complete within four months.
As you can see, there are many choices of treatments to improve acne scarring. The severity of the scarring and preference to how much “down time” a patient can have factors into which treatment may be the best. To determine which treatment is the right one for you, I will spend time during the consultation to understand you goals and time line you have to achieve these goals and together we will come up with a treatment plan.