Laser Treatment for Acne Scars in Sydney

Acne scars not only skin, but also destroys confidence and sense of wellbeing.  Despite advances in treatment of acne, acne scarring remains one of the most common causes of facial scarring. Fortunately, acne scarring is no longer a problem without a solution.

Acne scars come in a variety of shapes, sizes and degrees of severity. Different scar types respond best to specific treatments.  As most people have a combination of different scar types, this means best outcomes are most often achieved by using a combination of targeted treatments  which include lasers,   dermal fillers, TCA Cross, subcision, skin needling/rolling,  cortisone injections, microdermabrasion,  punch excision and surgery. There is no "one size fits all" treatment for the various types of scars. Differences in location, depth, size and number of scars all affect treatment decisions.  Acne scar treatments can range from non-invasive, with little or no ‘down time’, to more invasive treatments, depending on the individual patient’s situation or the result they would like to achieve.

It's important to be realistic about acne scarring treatments. Expectations of 30-70% improvement are realistic, expectations of 100% eradication are not, as the reality is that most scars can't be completely erased.

The only sure way to prevent or limit acne scarring is to treat acne early and for as long as necessary. Acne scarring usually results from severe cases of nodular or cystic acne. These types of acne penetrate deeply into the skin where eruption unleashes trapped bacteria that damage surrounding collagen tissue. Scarring occurs when collagen attempts to regrow, but does so in a disorganised manner, disrupting the natural healing process of the skin.  Early intervention is crucial to reducing the risk of scarring. A combination of over the counter or prescription acne treatments,   good cosmeceutical skin care and cosmetic treatments such as microdermabrasion and/or light peeling,  help  prevent acne scarring developing for the majority of sufferers.

Acne scars are classified according to shape, size and severity. This classification enables the physician to identify scar subtypes, and from there to develop targetted, appropriate and effective treatment protocols. Many patients suffer from a combination of different scar types and therefore do best with a combination of targeted treatments.

• Ice Pick Scars
  
  

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  Appearance: Ice pick scars are deep, very narrow scars that extend into the dermis. The skin looks as if it has been pierced by an ice pick or sharp instrument. Ice pick scars may appear as a small, deep "hole" in the skin or as a large, open pore. These scars are usually abundant and concentrate on the cheeks, forehead, and chin areas; other areas, such as the back, may also be affected.

  Development: Ice pick scars develop after an infection from a cyst or other deep inflamed blemish works its way to the surface. Skin tissue is destroyed, leaving a long column-like scar.

  Common treatments: Deep ice pick scars can be treated with TCA Cross, punch excision or punch grafting, whilst superficial dilated pore-like scars respond to fractional laser resurfacing.  

• Boxcar Scars
  
  

   

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  Appearance: Boxcar scars are round or oval depressions with steep vertical sides. Wider than ice picks, though often not as deep, boxcar scars give the skin a pitted appearance.

  Development: When an inflammatory breakout destroys collagen, tissue is lost. The skin over this area is left without support and a depressed area is created. Boxcar scars range from superficial to severe, depending on the amount of tissue lost.

  Common treatments: Treatments for boxcar scars include fractional laser resurfacing, TCA Cross, skin needling, and/or dermal fillers. Isolated box scars may be best treated with punch excision or grafting.

• Rolling Scars
  
  

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  Appearance: This type of scarring causes rolling or "wave-like" undulations across otherwise normal appearing skin.

  Development: Rolling scars arise when fibrous bands of tissue develop between the skin and the subcutaneous tissue below. These bands "pull" the epidermis, binding it to deeper structures of the skin and so creating a rolling appearance in the skin.

  Common treatments: Rolling scars can be the most difficult to treat because they can affect a large part of the face. Rolling scars are treated with fractional laser resurfacing, skin needling,  subcision (release from underlying tissue) or dermal filling. Dermal fillers placed underneath rolling acne scars can give them additional support and lift them to improve their appearance. 

• Hypertrophic or Keloid Scars
  
  

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  Appearance: A hypertrophic scar looks like a raised, firm mass of tissue. These types of scars often grow larger than the original wound. Hypertrophic scars caused by acne are most often found on the torso, especially in men.

  Development: Unlike ice pick or boxcar scars, hypertrophic scars are not caused by a loss of tissue. Rather, they develop because of an overproduction of collagen.

  Common treatments: Steroid (cortisone) creams, tapes, or injections are used to help shrink and flatten the scar. Lasers and Interferon injections are also used to soften scar tissue.

• Discoloured Acne Scars

  Appearance: Red or brown discolourations that remain after an acne lesion has healed.

  Development: Most discolourations are temporary and are part of the skin's healing and remodelling process, which can take 6-12 months. Usually, if no more acne lesions develop in the area, the skin can heal normally. Occasionally these colour changes persist for more than 12 months and are then considered to be permanent scars.

  Common treatments: Brown discolourations respond well to topical prescription skin lighteners. Red scars do well with vascular laser treatments.

• Grade I:

  Appearance: Scarring is visible regardless of distance and represents not a problem of contour like other scar grades, but of colour. The colour may be red, white or various shades of brown to black.

  Development: Red, white and brown to black scars each arise in different scenarios as the skin's response to injury.

  Common treatments: Time and optimised home care are sometimes all that is needed. Treatments for brown scars include prescription skin lighteners, light peels and microdermabrasion. Treatments for red scars include vascular lasers and IPLs. White scars have traditionally been difficult to treat, though there are some recent reports of re-pigmentation following manual dermabrasion and skin needling.

• Grade II:

  Appearance: Superficial rolling scars, not obvious at a social distance of 50cm or greater and may be covered with makeup, the natural shadow of a shaved beard, or body hair of off the face.

  Development: Mild tethering of the overlying skin to underlying structures.

  Common treatments: This group is susceptible to being over treated unnecessarily with aggressive resurfacing procedures. Less invasive procedures are the treatments of choice and these include fractional laser,  skin needling or rolling, microdermabrasion, subcision, dermal fillers.

• Grade III:

  Appearance: Obvious at a social distance of 50cm or greater, and is not covered easily with makeup, the natural shadow of a shaved beard or body hair. Scars are able to be flattened by manual stretching the skin. It equates to the moderate rolling or shallow box car scars and the moderate hypertrophic or keloid scars.

  Common Treatments: Erbium ablative laser, subcision, fractional laser resurfacing,  TCA Cross, dermabrasion, medical skin needling or rolling, dermal fillers,  injection of cortisone or fluorouracil, and/or vascular laser if hypertrophic.  Combinations of treatments are often most beneficial.

• Grade IV:

  Appearance: Scarring obvious at social distances of 50cm or greater, not easily covered by make up, natural shadow of shaved beard or body hair, and is NOT able to be flattened by manual stretching of the skin. This group comprises deep box car scars, ice pick scars, bridges and tunnels, deep rolling scars, hypertrophic and keloid scars.

  Common treatments: Resurfacing,TCA Cross, subcision, punch biopsies with or without resurfacing, cortisone injections, dermal fillers, vascular laser. Most sufferers may need a combination of two or more treatments to achieve optimum results.

Many sufferers need a combination of treatments to achieve optimum results.

• Lasers:

  A variety of lasers are used to treat acne scarring.  Vascular lasers reduce red scars and help soften keloid and hypertrophic scarring.  Ablative lasers  such as the Erbium YAG laser reduce the amount of scar visibility by removing  the outer layers of the skin, including its contained scar tissue,  as well as  stimulating dermal collagen to tighten.  Fractional laser resurfacing works in much the same way as  the Erbium laser, though only treats a fraction of the skin's surface at each session, thereby reducing downtime and delivering more gradual improvement.  

• TCA Cross:

  TCA Cross stands for Trichloracetic acid (TCA) chemical reconstruction of skin scarring (CROSS). It involves careful placement of strong acid directly into ice pick scars to induce new collagen and elastin production that help lift the scar and normalise skin texture. Healing is rapid and complications are rare because treatment is focused on individual scars whilst leaving adjacent healthy skin untreated.

• Subcision:

  Subcision is used to treat larger rolling or boxcar scars. A sharp needle  undermines the  scar and is manoeuvred to break fibrous bands of scar tissue  that are tethering the skin to underlying structures. Subcision also helps induce new collagen formation and is often combined with skin needling, TCA CROSS or laser treatments.

• Cortisone injections:

  Steroid creams, injections and impregnated tapes can also be beneficial for treating keloidal scars. Cortisone helps shrink thickened, raised fibrous scar tissue.

• Dermal Fillers:

  Dermal fillers are smooth gels  made up of our body’s own natural skin components.  When injected beneath the base of  shallow, saucer-shaped depressed acne scars fillers uplift the indented scar tissue and create a smoother skin surface.   Dermal fillers offer a temporary solution with the advantage that they are extremely safe and involve almost no downtime.

• Skin Needling/Rolling:

  Skin rolling stimulates the body's own natural healing processes to restore lost collagen and elastin in rolling and boxcar acne scars. Ultra fine, medical quality needles attached to a cylindrical roller create multiple skin punctures in the skin that induce a wound healing response. This results in new collagen and elastin production that helps smooth and repair acne scars. Skin rolling can be performed on both small or large areas of the face and is suitable for all skin types, including darker skin. This means skin rolling may be a safer alternative than laser for patients with Asian, Indian or African backgrounds.  Medical grade skin rolling treatments performed at the clinic can be augmented by skin rolling at home between visits.

• Microdermabrasion:

  Microdermabrasion is a minimal downtime treatment that   uses a combination of diamond brushes and suction to help  improve minor acne scarring. Recent studies confirm that microscopic exam of treated tissue shows significant improvement. 

• Chemical peels:

  Chemical peels are another method of treating the most superficial acne scars. Generally, medium to deep chemical peels are required to achieve a significant result, but a series of more superficial chemical peels could help achieve some improvement in milder acne scarring without significant downtime.

• Punch excision:

  Ice pick acne scars are often deep with hard, irregular jagged borders that are resistent to other treatment options. Simple excision of these scars and closure of the wound with a single stitch removes the scar completely and replaces it with a fine, uniform line.

• Topicals:

  Some patients report improvement in rolling scars, especially if relatively new, following application of silicone gels or tapes. Products that have been shown to stimulate collagen formation such as Ultraceuticals Vitamin C preparations and/or Vitamin A derivatives which help with exfoliation as well as stimulate collagen, are also to be encouraged as complementary to other acne scarring treatments.