Some people go through adolescence fairly unscathed and have no artifacts of their acne that caused them such grief and lowered their self esteem. Others are not so lucky, and are left with very obvious “pits” or “craters” or holes on their face that reminds them daily of the acne war zone that once plagued their skin. And of course most women eventually just cover these imperfections with makeup which can collect in these pits and make the lesions more obvious.
Not Really Acne Scars
People often call the discoloration after an active acne heals “acne scar.” This is technically PIH or post inflammatory hyperpigmentation and will eventually resolve but can be improved by bleaching creams, chemical peels and our Pastelle Q-switch laser. Similarly, some people refer to the inflammatory redness after an active acne breakout as “acne scar.” This redness is easily reduced with our IPL laser which targets the redness associated with the acne flare as well as the Propionobacterium Acne bacteria itself. True acne scarring is a textural disruption of the skin giving varying degrees of elevation and/or depression of the skin. So when making a consultation for an appointment to discuss “acne scars” make sure to let the staff and doctor know if it’s acne pigmentation and discoloration or one of the three types of acne scars discussed below.
Not All Acne Scars Are The Same
For the most part true “acne scarring” consists of 3 varieties:
Icepick: Very thin and deep scars that resemble someone driving an “icepick” into the skin.
Boxcar: Flat “crater-like” depressed scars
Rolling Scars: Deeper cave-like “craters” that have rolling edges.
Since acne scarring is permanent, there is no single modality that can 100% eradicate them and make them appear just like regular skin because it is a scar. Just as a burn scar can never be returned to 100% of its original appearance. Many aestheticians will offer microdermabrasion but this works very superficially and while can slightly improve the appearance and texture of the scar, does not attack the acne scar at the root of the problem, which is fibrous scar tissue deep in the dermis and subcutaneous tissues. Traditionally, fractional CO2 laser has frequently been used to improve acne scars but is extremely aggressive, causing a complete ablation of your skin and allowing the new skin to reform. This treatment requires a long downtime that many people cannot afford as well as multiple treatments. Microneedling and microneedling with PRP (also known as Vampire Facial) is also helpful for acne scars and have been used reliably for many many years. While these are eventually effective, they require multiple sessions in order to realize a satisfactory result.
The latest and greatest technology is using RadioFrequency Microneedling to treat these acne scars. Different from microneedling treatments you’ve come to know and love, Secret RF adds controlled radio-frequency energy to the mix to target deeper layers of skin while leaving the outer layer of skin intact. This device not only helps to treat active acne but also true acne scars. We like to refer to this treatment as microneedling “on steroids.”This treatment requires very low downtime (even less downtime than regular microneedling) and a minimum of 4 sessions spaced a minimum of 3 weeks apart.
In our toolkit we also can inject Bellafil, a filler that lasts 5 years and more and is FDA-approved for the treatment of distensible (ability to stretch scar and it flattens out) acne scars. They cannot be injected into icepick scars.
For the icepick scars, one can use TCA crosshatch, which involves dipping a thin needle or toothpick into a very strong acid Trichloroacetic Acid 70% and inserting just the tip into the icepick scar. This causes the inside core of the icepick scar to burn off and allowing new skin to form inside that core.
Subcision therapy can be used for the multiple large scars that have coalesced together and formed acne “towns,” causing the entire contour of the skin to become completely disfigured and irregular. Underneath the dermis of the skin these stubborn acne scars are like rubber bands that are pulling the skin down. The provider can use a sturdy needle to “cut and break” all of the fibrous bands pulling down the scar.
Of course, multiple treatment options can be combined for optimum results such as TCA/RF Microneedling; RF Microneedling/Bellafil injections; Subcision/RF Microneedling; IPL/Qswitch/ Chemical peel; subcision/Bellafil injections. Come visit Ageless MD and see how we can first optimize and control any active acne issues, and then work to significantly improve (but not remove) any disfiguring and unsightly acne scars.