Acne Scarring

Treatment of Acne Scarring

Several techniques can be used to try and improve the appearance of acne scarring. It is difficult to get rid of scars once they have formed so effective management of active acne is important to try and prevent them. If your acne is no longer active but you have been left with some scarring then the following techniques can be considered.

Please read the more detailed advice if you are considering any of these procedures. None of these techniques will completely remove your scars and there are risks associated with all the procedures.

Microdermabrasion of Acne Scars

Microdermabrasion smoothes and polishes the skin and is commonly referred to as the 'lunchtime peel' because the procedure takes only 20 minutes to perform and most people can return to work immediately. It is lighter than chemical peels, laser resurfacing and traditional dermabrasion. It is therefore safer, but the effects are more modest. It is helpful before intense pulse light treatment because removing this outer layer of skin enables the light to penetrate deeper. All skin types can be treated, but care must be taken with red faces as this can be exacerbated. Treatable conditions include sun damaged skin, enlarged pores, oily and acne prone skin, acne scars, blackheads and whiteheads, age spots and superficial pigmentation, & fine wrinkles.

What will happen?
A highly controlled vacuum and pressure system is used to move microscopically abrasive crystals over the surface of the skin. This action causes mild discomfort and removes the outer dead layer of skin. By repeating this process over the course of several weeks or months the skin feels softer and younger.

You should discontinue all face creams 5-7 days before treatment. Please do not wear makeup to the clinic. Plan to remove it before treatment. You will be asked to sign a consent form, your face will be gently cleansed and you will be given eye protection. The disposable applicator tip will then be moved back and forth over the skin surface, repeating in an overlapping fashion, avoiding the eyelids and soft tissue beneath the eye. It feels tight and mildly abrasive. Once the procedure is complete the crystals are brushed from your face. Your face will then be gently wiped with a cold cloth and moisturiser will be applied to the treated skin. This completes the procedure. You may apply makeup if you wish.

Do not do strenuous exercise for 12 hours after the initial microdermabrasion since this may cause excessive redness. Be sure to continue using a bland moisturiser. You may resume your normal skin products on the morning following the treatment, except for astringent cleansers. You may be slightly more sensitive to certain creams and alpha-hydroxy acids so you should avoid applying these products to the treated skin for 2 weeks. You may resume bathing and facial cleansing immediately following treatment, but avoid astringent alcohol based cleansing products for 5 to 7 days. You may be slightly more sun sensitive for 5 to 7 days following treatment. Please take the normal precautions of wearing sunblock and a hat.

Excision & Subcision of Acne Scars

What is it?
A surgical needle is used in subcision to release deep tethering beneath a scar. A punch biopsy is used to take out small scars, replacing them with smaller scars. Several scars can be treated in one procedure.

How does it work?
Removing tethering can help lift sunken scars and punch excision of ‘ice pick’ scars can replace it with a smaller neater scar.

What preparation is required?
You should not have these procedures if you have any skin infections or cold sores, or are prone to keloid scars. You will be asked to remove all make up and jewellery. Any medication you are taking will need to be checked and you will be asked if you are allergic to local anaesthetic.

What is it like?
The local anaesthetic stings while it is taking effect. You may feel some gentle tugging and pulling but this should not be painful. A stitch is used at each excision site. Some bruising and discomfort can be expected.

What are the risks?
There is a very small risk of keloid scar formation and wound infection. These may make your scars look worse. There maybe some bruising but this settles naturally.

What results can I expect?
There should be a gradual improvement in the appearance of the scars. The scars will not go but the aim is to make them less obvious. About half of patients are pleased with the effects. About a quarter notice some benefit, and another quarter do not feel it helps.

Fractional CO2 Laser treatment of acne scars

The fractional CO2 laser makes a powerful beam of light that removes part of the skin. Each shot with the laser covers about a square centimetre and is split up into grid of several hundred tiny beams. We call this type of laser a fractionated ablative photo rejuvenation laser. It can help the appearance of acne scarring, sun damaged skin, fine wrinkles and mottled pigment. It is not as aggressive as a peel or full laser resurfacing, it is safer but the results are more modest.

How does it work?
Each tiny laser beam penetrates into the collagen layer of the skin and removes a tiny core of skin the size of a hair. Hundreds of these tiny wounds are made every square centimetre. Removing part of the scar in this way decreases its size and also the injury stimulates new collagen to form.

What preparation is required?
You should avoid all sun exposure for a month before treatment and throughout your treatment. You should not have treatment if you have a skin infection or a cold sore. If you are prone to cold sores preventative medicine will be required. Your face must be cleaned of all make up and there must be no artificial tan. Any medication you take will be checked. In particular if you take, anticoagulants, Roaccuttane, gold injections, or immuno-suppressants. You have to wait a year after stopping Roaccuttane before laser resurfacing. You should not have laser treatment if you are epileptic, pregnant, have had skin cancer, have a darker skin type, are tanned, are prone to keloid scars, or have had other facial procedures in the past year. Men should have a close shave on the day of treatment.

What is it like?
The procedure will take about half an hour. Topical anaesthetic will be applied an hour before under a cling film wrap. You will wear blindfold goggles during the treatment. The laser blows cold air on your face and each zap feels hot and sharp for a second. The heat builds up during the treatment and for an hour after wards it will feel quite hot. The treated area will look red for a week, longer if you have had an intensive treatment. An anti inflammatory steroid cream will be applied to your face before you leave.

What are the risks?
The laser light can damage your eyes and you must wear safety goggles to protect your sight. Side effects are rare but include unwanted pigment changes, either pale marks, or dark marks. These usually gradually improve. Blistering can occur if the treated area gets too hot. If the blisters or scabs are picked or scratched then scarring may result. Skin infections are possible through the small wounds, these increase the risk of scarring. The laser is not thought to be cancer forming.

What results can I expect?
There maybe an immediate temporary improvement due to some mild swelling, this may persist in a subtle way for several weeks. New collagen takes a few months to show. The benefit is slow. About a third of patients have a noticeable improvement by 6 months, another third a mild improvement and another third not much improvement.

What aftercare is required?
We will apply a steroid cream to your face before leaving the clinic to reduce the inflammation. Your face will be puffy for a couple of days. Ice packs and paracetamol will make you feel more comfortable. It is important not to rub pick or scratch even if it is itchy. You should apply Vaseline from a new clean pot twice a day and keep out of the sun. Redness will persist for many days and can be disguised with makeup. No alcohol aspirin or anti-inflammatory drugs like Ibuprofen for one week. If leaving the house wear factor 50 SPF sunblock with 4 or 5 star UV protection. Use a new clean tube. Suitable products include Boots Soltan range, Anthelios XL by La Roche Posay, and Sunsense Ultra. You must not try and tan your face for six months.
* Results may vary from Person to Person
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