Mild acne scar treatment
I would interested to know personal or professional opinions about the
various treatments of facial acne scars. Is dermabrasion no longer the
way to go? Is laser surgery necessary? How about special lotions and
chemical peals? I am male and caucasian. Does gender/skin color play a
role in my decision?
Scars can be classified as hypertrophic (seen as a ridge within the
confines of the original wound), keloid (large sometimes dumbell shaped
scars that grow out of the confines of the original wound) or widened
& depressed.
What makes the scar noticeable is the difference in topography or color
from the surrounding normal skin.
The techniques I have found to make scars less noticeable are changing
scar direction so it lies within a normal skin crease or fold, debulking
procedures, local steroid injection, medical grade skin tatoos, application
of
a pressure dressing &/or silastic sheeting, & laser treatments. Which
technique
or combination of techniques to apply for the best result requires a
qualified
trained physician. Keloids in general require debulking, steroid injections
& pressure garments or earrings. They require long term follow up with
the treating physician as they are not cureable only controlable. Keloids do
not
respond to silicone sheeting. Hypertrophic scars are sometimes treated
in the same fashion but are more amenable to laser treatments, silastic
sheeting & pressure
garments. I would need to examine the area in question in order to
give you a specific recommendation.
With acne scarring the problem is a difference in topography whereby
the scar surface is at a deeper level than the surrounding skin.
The scars are noticeable because of the shadows that fall over them in
a fashion analogous to the shadow on a street with tall buildings on either
side. To rectify this you need to raise the street &/or lower the buildings.
The best current techniques to do this are to make small incisions around
the edges of the small scars. This does not add new scars to the skin
surface because the incisions
are made within the confines of the acne scar pit. Not every scar is a
candidate for this.
The scar has to be small enough & the depth of the pit must have enough
remaining layers of skin
to contract with healing. As these incisions heal the scar is squeezed
by the surrounding healing procees. This causes this skin to pucker-raising
the street. About 6 weeks later CO2 or Erbium laser is used to even out the
skin
surface under magnification. Some physicians place a dermal filler to raise
the scars but there currently are no very good fillers available. Using
laser alone only results in a 30 to 60% improvement. Despite this it may
take more than one laser resurfacing to achieve the desired improvement.
Additionally, the acne would need to be quiescent to carry out this therapy.
The treatment can also reactivate acne so close post treatment follow up
is called for. In some cases the depressed areas can be quite large in
which case the only advisable treatment is scar excision.
The ultimate goal seldom achieved is to hide a scar so that it is not
visible to the unaided eye & the area in question looks as though
nothing untoward has occurred.