Acne Scar Revision
Acne is one of the most common skin disorders experienced by up to 80% of
people between 11 and 30 years of age. For most people, acne is a nuisance
and leaves little in the way of lasting marks. Prevention of acne scarring
is most often the key motivation behind treatment. For some unfortunate
people, however, acne can leave both mental and physical scarring.
Evaluating the face for the types of scars present will help determine the
best treatment.
Acne scarring can be divided into 3 basic types: Boxcar, ice pick and
rolling scars. Boxcar scars are shallow to deep, visually distinct
depressions. They are usually 1-4 mm in diameter. Shallow boxcar scars can
usually be treated by skin resurfacing techniques such as laser resurfacing.
Wider and deeper scars are more effectively treated by punch elevation or
excision.
Ice pick scars are narrow visually distinct tracts that descend vertically
into the deeper layer surface skin. Because of their depth, resurfacing
techniques cannot adequately treat these scars. Punch excision is the best
therapy here with a single stitch closing the tiny hole.
Rolling scars are depressed scars of otherwise normal looking tissue. They
are held down by fibers that tether the skin to underlying tissues, lighting
tends to accentuate these scars, producing unwanted shadows. Because they
are usually shallow, treatment of the overlying skin will not give good
results. Silicone Microdroplet therapy is the most successful filler
treatment for acne scars. It has been combined with subcision, and great
results are seen. Subcision is the preferred technique to treat bound-down
rolling scars, often followed by Silicone Microdroplet therapy and finished
with fractional CO2 or Erbium:YAG laser resurfacing.
Subcision is a simple technique designed to free the tethering fibers from
the overlying skin. A special needle with a cutting tip is used to slice
these bands. Three tiny incision points are used to treat each site. These
incisions heal without visible mark. The doctor, with the patient guiding
him, marks the areas to be treated. The areas to be released are then
treated using a piston-like motion to cut the bands. It is like cutting the
ropes that hold a balloon to the earth. Upon completion of the treatment,
the areas are dressed and bandaged. Bleeding is rare in most cases.
Overabundant healing can occur and is easily treated. Bruising, if it
occurs, usually fades within 1-2 weeks.
It is important to remember when undergoing any treatment for acne scars
that improvement is the goal. Several treatments may be necessary to achieve
optimal correction. Combining these different procedures may be needed to
better address individual problems. Additional sessions to treat other areas
or to retreat previously addressed areas can be scheduled at monthly
intervals.
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