Wednesday, April 22, 2015

What Can I Do About Acne Scars?

"What can you do about my acne scars?" This may be the most common question I get asked. Acne scars often make people very self conscious, especially younger folks. Decades ago there wasn't a lot that could be done for them. It can be a very difficult problem to treat, but certainly not impossible. Acne scars require patience and diligence from both the doctor and the patient. I have a friend who underwent an aggressive laser treatment with significant downtime, not to mention expense, but hasn't had significant improvement in her scarring.  Many of the people I see for scar treatment have previously had Fraxel as well.

At Sei Bella I have a multi-technique type of approach to acne treatment. Different procedures work in different ways. Different products work in different ways.  Below is a summary of the way I like to approach scars. First, though, let me define the various types of acne scars.

Ice pick scars: Deep pits are the most common and a classic sign of acne scarring. Often the most difficult to treat.

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.

Rolling scars: Scars that give the skin a wave-like appearance.

Hypertrophic scars: Thickened, or keloid scars. Most often seen in African American patients.

My approach to treating acne scars includes both products and procedures and you won't have the downtime associated with laser. 
  • Rejuvapen:  This utilizes 9 precisely spaced micro needles in a small cartridge to create invisible, vertical micro perforations in the epidermis and top layer of the dermis. As a result, the skin shifts itself into high gear and starts producing collagen and elastin to repair these micro-perforations. Not only does this procedure allow your skin to repair itself naturally, it also aids in the absorption of peptides we apply and growth factors you use at home. This is not painful. We numb the skin of your face for about 30 minutes with a numbing cream prior to the procedure. I've had it done myself as well as my office staff. Your face is quite red after the procedure, but is easily covered with makeup and almost all the redness is resolved in 48 hours.  You may need one to three treatments about a month apart. (see before and after picture below)

  • Medical Grade Facial Peels: Our Perfect Derma Peel is TCA (trichloracetic acid) based and is an excellent peel for everyone including those of darker ethnicities. In May we are introducing 10 new peels, though, so that we can better tailor to specific skin problems. It depends on whether or not your acne is still active, or whether you have a lot of discoloration, whether your skin is oily, dry, etc. which peel I will recommend. You may need to get more than one peel, but they would be done 1-2 months apart. Medical grade facial peels help with the more superficial scarring and discoloration from acne.

  •  Growth Factors: As your skin heals, new cells need to be stimulated to grow correctly (and quickly). Besides the copper peptide we apply to your skin with the Rejuvapen procedure, we also apply our Regenica repair serum.  The Regenica product line was developed by Dr. Gail Naughton, a leading scientist in regenerative medicine. I have used Regenica's day and night cream for the last 8 months and love it. These will be great maintenance products for you. In a recent study 100% of patients would recommend these products to a friend and 100% said their skin looked more healthy.  94% saw a more even skin tone and felt the texture of their skin had improved.

  • BellaFill: This is the newest long lasting filler on the market. It has been recently been FDA approved for acne scars, not just volume replacement. BellaFill is not for all scars. (see above scar definitions). BellaFill does NOT work well on ice pick scars at all. It's not needed on the hypertrophic, keloid type scars. But the box car scars and rolling scars can definitely be improved. BellaFill is usually done AFTER Rejuvapen and medical grade facial peels. The top set of pictures below shows the type of scars that can be treated successfully with BellaFill. The bottom set of  pictures were taken approximately 8 weeks apart. This lady had cystic acne acne scarring. After breaking up the scar tissue with a cannula, I placed two syringes of BellaFill in the chin area. 

  • 4% hydroquinone and tretinoin .05%/.1%: and finally as I said above, acne scars cause not only uneven skin texture, but also uneven skin tone with brown and red spots. IPL does help these, but to treat discoloration aggressively I need to have you using a product with 4% hydroquinone in it like Obagi-C-clarifying serum or c-therapy night cream. In addition I like to have you start using 0.05% tretinoin at night a few days a week, working up to 0.1% tretinoin several nights a week. Tretinoin has been proven in many studies to be one of the best ant-aging products available. 
I'd be happy to see you in consultation and evaluate your skin, letting you know what I think you will need and what you can expect. Again, patience and diligence are the keys along with products and procedures that work in different ways to improve your scarring and increase your self confidence.

Anne R Trussell MD

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