Acne scars are much more treatable than in the recent past
Acne can produce a range of scars. Some are sunken (called atrophic) and some raised (called hypertrophic).
Whilst perfect skin with complete elimination of the scars is not usually attainable, three methods produce substantial, sustained improvement, which up to a few years ago was impossible to achieve.
It is important to address the inflammatory/infective component of acne before embarking on scar treatment due to the risk of cross infecting one area onto another
Atrophic scars are classified according to the shape of the scar:
Box-car type scars
The dermis underlying atrophic scars tends to be thinned and scarred. A major component of management of these scars is therefore to release the tethering that holds these scars sunken down, and repair the dermis.
Broadly, treatment of atrophic acne scarring falls into one of three categories:
There has been some real innovation here with the introduction of air pressure devices such as Enerjet™ which injects medications at very high pressure into the skin, in a pain-free needle-free way. The compressed injection blasts the scar, filling the resulting cavity with medication that the body replaces with its own collagen.
A real innovation in the field is subcutaneous single bare fiber (Lasemar™). In this expert procedure, laser energy is delivered under the skin through a single-use fibreoptic, thinner than the diameter of a single hair, allowing much deeper and complex scarring to be addressed.
A less-often practised technique is punch scar excision. Here, irregular, deeply tethered and otherwise untreatable scars are taken out with a bioptic tool and discarded. The resultant defect is then sutured “along the grain” with a special suture, converting an irregular sunken scar to a “neat”, well-healed surgical scar, which is flat and can be covered with make-up. This kind of treatment is contra-indicated in hypertrophic scars.
Once the base of the scar has been raised as much as possible, the roughness of the surface needs addressing. Under various techniques, fractional ablative lasers are here used to smoothen the skin surface.
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