Subscribe to receive educational newsletters, exclusive discounts & promotional offers!
Acne Scars
Severe acne can lead to significant scarring on the face, which can be emotionally very upsetting and have a devastating psychological impact. Acne scars can be difficult to treat. There are various forms of acne scars. Boxcar scars, ice pick scars, rolling scar and hypertrophic scars. Typically, one could see all of these type of scars in the same person. The reason why we differentiate between the various forms is because the treatment varies for each type. Below I will review the various options available. Please note that one modality of therapy may not give you the best result and various modalities must be used to achieve a good result. Various modalities include Fractional CO2 laser, chemical peels, Fraxel laser, subcision, punch excision, CROSS technique and fillers like Restylane and Juvederm Ultra.
Fractional CO2 Laser (The GOLD Standard)
The gold standard for acne scars is the fractional CO2 laser. The fractional CO2 laser is a 10,600 nm ablative laser that drills tiny zones or columns in the treated area. Between these columns, there exists intact skin, which allow for collagen stimulation and healing. As skin remodeling occurs, the acne scars improve because the collagen fills in the scars.Compared to traditional fully ablative CO2 laser, the fractional CO2 has significantly less downtime with comparable great results. Typically, more than one treatment is needed depending upon the level of severity of acne scarring. The fractional CO2 works for all types of acne scars and it also allows us to treat darker skin individuals as well, including Hispanics.
Fully ablative CO2 resurfacing
Fully ablative CO2 laser used to be the gold standard for acne treatment. However it has gone out of favor because of the increased risk of side effects, increased downtime and the need for general anesthesia.
Punch Excision
For boxcar scars on the face, the area can be numbed and punched out. Although you will replace one scar with another, the newly created one is linear and not depressed, which makes it look more pleasant aesthetically.
Fraxel
Fraxel Repair is a 1550 nm non-ablative laser indicated for acne scars. It works by stimulating collagen in the acne scar areas. Typically, the whole face is treated and 4 to 5 sessions are needed. The downtime is less than the Fractional CO2 lasers because it is not ablative.
Subcision
Subcision is a technique intended to improve the appearance of acne scars. Subcision can be effective in rolling and boxcar scars. It is a minimally invasive surgical procedure performed in Dr. Behnam's office. A needle is used to puncture through the surface of the skin and cut the fibrous scar tissue pulling down the surface skin. This allows the skin to be lifted since it is not bound down anymore and improves the appearance of the depressed scar.
CROSS Technique
TCA Cross technique is the application of Trichloroacetic Acid 90% into ice pick or boxcar scars, stimulating collagen production in the scar. It is very effective but may need to be repeated multiple times.
Saline Injection
Saline injection is another technique that may help acne scars. This only works for certain type of acne scars known as rolling scars. Bacteriostatic saline is injected within the acne scar lesion intradermally, raising a bleb. Performing this 4 to 6 times every two weeks apart will result in a significant improvement of acne scars. The most common side effects are redness and swelling, which only last several hours. The procedure takes about 10 minutes each time, it is tolerated well and topical numbing is used prior to the procedure.
Chemical Peels
Jessner's peel are very effective in treating acne scars. Jessner's peels consist of Resorcinol, Salicylic Acid and Lactic Acid. The face is cleansed with alcohol and then the Jessner's solution is applied. Several coats are applied depending on the reaction observed after every coat. Patients will peel for a few days. Several sessions are required and the acne scars will look better.
