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Erase the Past: Treating Acne Scars

Updated: Mar 17


acne scars

Acne, a common skin condition, affects millions worldwide, leaving behind not just physical but emotional imprints on people who suffer from it. While acne itself can be distressing, the scars it leaves behind often pose an enduring challenge, affecting self-confidence and self-esteem.

Acne scars form as a result of inflammatory acne lesions, where the skin tissue is damaged during the healing process. There are two main types of scars: atrophic scars, which appear as a depression in the skin, and raised scars that include hypertrophic and keloid scars. Each type requires a unique approach to treatment.



Prevention is better than cure

Preventing new acne breakouts and treating acne early before scar formation is crucial. A proper skincare products and routine that involve gentle cleansing, non-comedogenic products, and sun protection can create a stable environment for your skin. If your acne persists despite using over-the-counter skincare products, consultation with doctor is necessary for appropriate treatment. Treatment can include topicals, oral medications, procedural treatments or combination based on the severity of your acne.



Types of acne scars

types of acne scars

types of acne scars

Atrophic scars develop when there is insufficient collagen production during the skin’s repair after a breakout. There are three main types of atrophic acne scars:


1. Rolling scar

Rolling scars are wide depressions with shallow edge, giving the skin a wave-like appearance. They result from the damage and tethering of underlying tissue. This happens when skin heals from inflammation, fibrous bands form underneath, pulling the epidermis downwards and creating the rolling or undulating appearance.


2. Boxcar scar

Boxcar scars are broader depressions with well- defined edges.


3. Icepick scar

Icepick scars are deep and narrow. They develop when an inflamed acne follicle collapses, causing a deep pit in the skin.


Hypertrophic scars and keloids are types of raised scars that can develop after acne lesions have healed.


keloid, hypertrophic acne scars

1. Hypertrophic scars

Hypertrophic scars develop due to an overproduction of collagen during the healing process of acne lesions. When the body repairs the skin after acne, excess collagen is produced, leading to the raised and thickened appearance characteristic of hypertrophic scars. They are located at the site of healed pimple, and do not extend beyond the boundaries of the original acne lesion.


2. Keloids

Keloids result from an overgrowth of scar tissue beyond the boundaries of the original wound or acne lesion. They can have a rubbery or hard consistency, and can be itchy, painful, and extend into surrounding healthy skin. Keloids can develop after severe or deep acne lesions, especially in individuals with a genetic predisposition to keloid formation. Hypertrophic and keloid scars can affect people of any race, ethnicity, or population. However, it is noted that individuals with darker skin tones, particularly those of African, Hispanic, and Asian descent, are more prone to developing hypertrophic and keloid scars. These scars tend to be more noticeable and prevalent in people with darker skin tone.


They can develop not only after acne resolves but also following various forms of injury, including trauma, surgical procedures, injections, and piercings.


In general, scars are common in individuals who experience severe or inflamed acne. Picking, squeezing, or manipulating acne lesions can increase the risk of developing scars.


There is a range of treatments available for atrophic scars, including:


microneedling
Dermapen

Microneedling

As its name suggest, it basically utilizes a device equipped with multiple tiny, sterile needles to create micro-injuries in the skin. There are three basic forms of microneedling devices: the dermaroller, which is dragged across the skin to create punctures, dermapen, which creates punctures in skin in a high-speed stamping motion, and derma stamp that works just like a stamp to push microneedles into the skin that needs to be treated. It works by creating controlled injuries to the skin, triggering the body’s natural healing response and stimulates collagen production, hence improving the appearance of atrophic scars.





Subcision


subcision

Subcision is for scars that are tethered to underlying tissues, causing them to appear depressed or uneven, such as rolling acne scars. Cannula is inserted beneath the skin through a tiny incision made in the skin’s surface. The cannula is then moved back and forth in a controlled manner. This motion helps release the fibrous bands that are pulling the scar downward, allowing the depressed area to lift and become more level with the surrounding skin.




Chemical peel


chemical peel treatment

Chemical solution is applied to the skin, causing it to exfoliate and peel off in few days. This process encourages new, healthier skin to replace the old, damaged skin, resulting in a smoother skin.



Frosting from TCA cross
Frosting from TCA cross

In cases when the scars are deep like icepick or deep boxcar scars, TCA cross is used. TCA cross is a procedure used to treat acne scars, particularly ice pick scars. Unlike traditional chemical peels that are applied over the entire face, TCA cross targets specific scars. A high concentration of trichloroacetic acid (TCA) is precisely applied to the base of each individual acne scar. The acid penetrates the skin, causing controlled damage to the scar tissue. Skin then undergoes healing process, during which new collagen forms. This collagen production helps to elevate and fill in the depressed scar, making it less noticeable.


The whitish discoloration is called frosting, which occurs 30 seconds to 2 minutes after application. This frosting effect is a result of protein coagulation in the epidermis caused by the reaction of TCA with the skin proteins. It indicated the precise penetration of the acid and suggests that the treatment is working as intended. Frosting is a temporary reaction.




Laser resurfacing

Ablative lasers emit high- energy light pulses that vaporize or remove the outer layers of skin, allowing fresh skin to emerge.


fully ablative laser

fractional ablative laser

Ablative lasers are available in fractional and fully ablative forms. Fractional lasers target columns of skin tissue, leaving adjacent areas untouched to optimize the healing process. In contrast, fully ablative lasers remove the entire outer skin layer and penetrate the underlying dermis with heat. Recovery after fully ablative treatments typically involves more downtime and careful aftercare, and pose risks for individuals with dark skin tones due to potential pigmentation issues. Nevertheless, its ability to effectively treat acne scars is unquestionable.


Another option for resurfacing without damaging too much burn of the superficial skin is the Sublative treatment. Whereby RF energy is shot below the skin.




Radiofrequency microneedling

RF microneedling is a minimally invasive procedure that combines microneedling with radiofrequency energy to rejuvenate the skin and improve its texture. There are multiple microneedles fixed onto the device, and the microneedles penetrate your skin and deliver radiofrequency at a preset depth.


Potenza Radiofrequency Microneedling
Potenza Radiofrequency Microneedling

It differs from ablative lasers in several aspects. Ablative lasers remove the layers of skin from epidermis to dermis, whereas RF microneedling spares the epidermis, as insulated needles penetrate into your skin at a preset depth in dermal layer, where scars reside, before delivery of energy. Because of this, RF microneedling has lesser downtime and is safer for individuals with darker skin tone due to lower risk of postinflammatory hyperpigmentation. Besides, ablative lasers also cannot reach as deep as RF microneedling, making them less effective when used as a standalone treatment for deep scars.




Rejuran S


rejuran s

Rejuran S is gaining popularity as a treatment for acne scars. Rejuran S contains polynucleotides, which are DNA fragments extracted from salmon and has excellent biocompatibility with human skin without any immune response. Polynucleotide have regenerative and healing properties, thus is used for skin rejuvenation. Rejuran S has higher viscosity compared to other range of Rejuran, enabling it to plump the depressed area, making scars appear less noticeable instantly. However, the plumping effect is temporary and does not reflect the final outcome of the treatment. The complete benefits of the treatment become evident over several months when new and more collagen are formed.




Dermal filler

Dermal filler adds volume to the depressed areas, raising the depressed areas to the level of surrounding skin. This approach provides immediate results, although it's temporary and requires periodic touch-ups.


Punch excisions

For deep or stubborn scars, punch excisions involve removing the scar and stitching the skin back together. This method is particularly effective for ice pick scars.


Treatments for keloid and hypertrophic acne scars include steroid injection, application of silicone sheets or gels, pressure dressing, laser treatments or surgical excision of scar tissue.


Acne scars in darker skin

Addressing acne scars in individuals with darker skin tones presents a distinctive challenge. Darker skin naturally contains more melanin, the pigment responsible for skin colour. Procedures that penetrate the skin’s upper layer can potentially lead to post-inflammatory hyperpigmentation (PIH). While PIH is a common part of healing process for people with darker skin, dissatisfaction among clients might lead to non-compliance or discontinuation of treatment sessions. Besides, to minimise the risk of post-inflammatory hyperpigmentation, gentler treatment settings are often employed, necessitating more sessions for effective results.


For darker skin type, it is essential to use specific skincare ingredients before and after the procedure and protect the treated area from sun exposure during the healing process to prevent PIH.


Improving acne scars demands patience and commitment. Deep scars often necessitate a combination of diverse treatments. A consultation is essential to determine the most suitable therapies tailored to your specific scars and skin type.


Dark spots and red spots after acne


After acne heals, skin sometimes develops dark and red spots, referred to as postinflammatory hyperpigmentation (PIH) and postinflammatory erythema respectively. PIH arises from abnormal melanin production and deposition after inflammation, leading to dark spots. Postinflammatory erythema, on the other hand, results from damage and dilation of small blood vessels due to inflammation, causing red spots. While both conditions are temporary, they can persist for months or even years without treatment.


Home DIY microneedling YAY or NAY?

In recent years, microneedling has emerged as a highly sought-after aesthetic treatment, gaining immense popularity among individuals seeking to enhance their skin’s appearance. Microneedling does not only improve scars, but the procedure also facilitates improved absorption of skincare products into the skin, as the punctures created by the microneedles allow for deeper penetration through the skin’s primary barrier, the stratum corneum. This, in turns, can lead to a more profound and long- lasting improvement in the skin’s texture, tone and overall appearance. Microneedling is a beneficial treatment for a range of skin conditions, extending beyond scars to address issues like fine lines, hyperpigmentation, postinflammatory erythema, enlarged pores, and stretch marks.


While professional microneedling is performed by licensed aestheticians or dermatologists, the skyrocketing popularity of microneedling has led to a surge in the use of at-home DIY devices. Yet, the crucial question that beckons attention is whether it is prudent to undertake microneedling at home with such devices, considering the potential safety concerns.


Professional microneedling VS home microneedling


RISK OF INFECTION

Risk of infection is one significant aspect. Microneedling should be conducted in a clean environment with sterile tools, and appropriate skin preparation and after-care are essential. When performed at home, the lack of sterility and proper care increases the likelihood of infection. The risk further compounds when the same device head is repeatedly used. Conversely, professional microneedling is conducted in a controlled and sterile environment, minimizing the risk of infection.


RESULT

Microneedling require knowledge of anatomy and proper training to utilize correctly. Microneedling done by professionals ensures optimal outcomes by controlling depth and speed of the device based on area of the face and specific indication. Furthermore, professionals use more advanced microneedling devices with longer needles to achieve more noticeable results. However, in the hands of an amateur, long needles can post a threat to safety.


SAFETY PROFILE

In today’s era, the advent of social media has enabled individuals to share their own “how-to” guides on various topics, including skincare. However, incorrect techniques can result in suboptimal outcomes, such as unsightly scarring.


The idea of at-home microneedling may seem like a convenient and affordable way to achieve smoother, more youthful-looking skin, it is not without risks. Improper use of the device can lead to unwanted outcomes like infection and scarring. Although home microneedling can be beneficial when it is done correctly, it is an indisputable fact that professional microneedling produces superior results with better safety profile.