Treatment of Acne, Acne Scars, and Scar Revision

Acne is a common skin condition, especially among teenagers. Traditional treatments include topical creams and lotions as well as systemic treatment with antibiotics and occasionally Roaccutane. Lasers and light treatments have recently been developed for individuals who either fail to respond to traditional treatment of for those who prefer to avoid taking pills. These devices work by killing bacteria found in acne and also by shrinking sebaceous glands. The Smooth Beam, Thermage, Blue light, as well as ALA photodynamic therapy can be used to treat acne.

Not everyone develops the scarring that can occur after outbreaks, and it can be almost impossible to predict which patients will scar. There are many ways to treat acne scarring. In addition, other forms of scars can be very difficult to manage and improve.

There are many different types of acne scars. Deep pits that develop following an acne lesion are called "ice pick scars", and are a classic sign of acne scarring. Angular scars (boxcar scars) usually occur on the temple and cheeks, and can be either superficial or deep. Scars that give the skin an undulating appearance are known as "rolling scars". Many patients require a combination of treatments for the best results.

Because each patient is unique, it requires a special set of skills to properly evaluate and manage patients with scars. We will carefully evaluate your skin, develop a comprehensive treatment program and recommend the most recent and innovative techniques needed to treat patients

Scar Revision

Traumatic, accidental, old and new scars can often benefit from surgical intervention. Available treatments include surgical revision and excision, laser therapy, and intralesional or topical therapy. For many patients, a combination approach is indicated. Some scars will not improve with treatment. We take the time to explain to you the possible risks and benefits of treatment, as well as the likelihood of success. Fortunately, most scars do improve with intervention.

Rolling Acne Scars

Rolling scars are the subtle or sometimes pronounced undulations that occur in acne prone skin. These are often the scars that are most noticeable in varying types of room lighting. Injection with soft tissue fillers such as collagen may provide temporary relief from rolling scars. For this reason, it is often best to use this therapy in combination with other cosmetic procedures. Subcision is a technique that is quite successful at eliminating soft, depressed scars. These types of scars can be a challenge to treat. In addition to subcision, other injectable substances such as Collagen, Restylane, Perlane, and Aquamid can be used to improve the appearance of depressed scars.

Boxcar Acne Scars

Boxcar scars are usually small, clearly defined indentations in the skin. They occur all over the face, most notably on the temples and cheeks. Treatment of shallow boxcar scars can be accomplished with laser skin resurfacing, but deeper boxcar scars are best removed surgically. Direct excision with suturing is one of many treatment options available.

Ice Pick Acne Scars

The only successful treatment for ice pick scars is surgical removal. Following the surgical removal of ice pick scars, most patients benefit from skin resurfacing using one of several lasers. The laser treatments result in soft, smooth, unscarred skin by removing surface layers of the skin. The laser treatment is usually performed 6 to 12 weeks after surgical removal of the scars so that the area where the scars have been removed will improve maximally. Occasionally, the surgical excision of the scars is performed immediately after laser resurfacing. Patients notice a dramatic improvement 4 to 6 weeks after the procedure.

Non- Ablative Resurfacing

In many cases scar improvement with non-invasive lasers such as the Smooth Beam and other devices can be accomplished. A series of 6 procedures is performed once a month for 6 months to achieve the best possible result. The treatments are somewhat uncomfortable so we usually recommend the application of a topical anesthetic, such as EMLA for an hour before each treatment. Once the cream is applied the treatments are very well tolerated. Improvement is usually seen after the 3rd or 4th treatment. Slight redness is seen for about an hour after each treatment but scabbing and crusting are rare.

Laser Resurfacing for Acne Scars

Laser resurfacing is one of the most useful techniques in the treatment of acne scarring. With this procedure, thin layers of skin are removed, layer after layer, until the scars improve or disappear. At the same time the skin tightens to help smooth out the scars. Laser resurfacing is often combined with one or several other treatments for acne scars, and this combination approach consistently yields superior results compared to other therapies. In most cases, the surgical treatment of scars is completed prior to laser resurfacing. The laser treatment is scheduled 6 to 12 weeks after the last surgical treatment to allow your skin time to heal and remodel. Laser resurfacing is superb for treating shallow boxcar scars, as well as for smoothing and tightening scars that have been treated with other surgical modalities such as subcision and excision. For individuals who are interested in laser treatment of acne scars, but are interested in a less invasive procedure, non-ablative resurfacing with the Smooth Beam laser offers the potential for significant improvement.

A surgical procedure is often required in order to remove deeper scars and make them dramatically less noticeable. Laser resurfacing procedures can remove the scars that remain. This combination approach yields results that are consistently excellent, setting a new standard of care in this area.



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