ACNE SCARS PROGRAMME
Acne scars occur as a result of a full thickness injury to the skin from inflammatory acne, most notably nodulocystic acne. The injury involves the dermis layer of the skin, resulting in irregularities on the surface of the skin. Acne scars are different from post-inflammatory pigmentation, acne marks or blemishes which are temporary and usually resolve with time on their own.
Scars are, by definition, permanent and irreversible. However, there are methods to make them less obvious. When treating acne scars, the first step is to ensure good acne control as some treatments may trigger breakouts. Next, it is important to identify the type of scars present, as this will determine which treatments are the most suitable.
Common scar types include rolling scars, boxcar scars and ice pick scars.
These scars typically have edges with a gentle gradient. They have the appearance of mountains and valleys. They may get more obvious with age.
Rolling scars are best treated with a series of subcision, followed by CO2 laser or radiofrequency microneedle.
These are scars that are wide and have steep, perpendicular walls. They may be triangular, square or rectangular, in the shape of a matchbox.
They are best treated with subcision, followed by CO2 laser or radiofrequency microneedle. If small, they can also be treated effectively with TCA CROSS.
These scars are narrow and deep, with steep edges, giving the appearance of being created by an ice pick.
As the base of these scars tend to go very deep, lasers are not very effective in treating them. TCA CROSS, where small amounts of TCA are applied to the base of the scars with an applicator, is one of the few ways that are effective in treating these scars. Alternatively, they can also be excised by a plastic surgeon or dermatologist trained in surgical procedures.
Treating acne scars is a long process and we urge those seeking treatment to be patient. The Astute programme is a 1-year programme that consists of treatments and skin care products. We recommend spacing out treatments to at least 6 weeks apart to give the skin enough time to recover and improve.
STEP 1 - RETIN A
In general, we would like to start our patients on a daily application of Retin A. This simple Vitamin A cream has been found to stimulate collagen production, improving the appearance of scars after several months of application. It is also synergistic with other acne scar treatments, improving results, while decreasing the risk of side effects like post inflammatory hyperpigmentation.
Retin A needs to be stopped 1 week before each treatment and should only be resumed after the skin has fully recovered.
STEP 2A - SUBCISION
Subcision should be one of the first steps in treating acne scars. This treatment breaks up the deeper scars that are situated beneath the skin, or deep in the skin that energy-based devices cannot reach. Small amounts of Radiesse are placed where the scars have been broken to prevent them from reattaching. Radiesse also stimulates collagen production, giving better results. The doctor’s experience is key as the right layers of the skin need to be accurately targeted for safe and optimal results.
STEP 2B - TCA CROSS
TCA CROSS is one of the few ways of treating ice pick scars. It is also suitable for smaller boxcar scars. These scars are too deep for lasers to reach and must be manually treated with TCA. An experienced practitioner is essential during this step to minimize the risk of adverse side effects like the widening of scars.
STEP 3A - FRACTIONAL CO2 LASER
We recommend using the CO2 laser during the later stages of treatment when the deeper scars have been made shallower with other treatments. The CO2 laser smoothes out the skin and stimulates the skin to regenerate in the scarred areas, making them shallower in the process.
We use the Deka Smartxide CO2 Laser at our clinic, which is one of the leading brands of CO2 lasers in the market. Using a reliable CO2 laser machine is important, as it allows us to individualise treatment parameters for each patient, delivering more effective and safer treatments.
STEP 3B - RADIOFREQUENCY MICRONEEDLE
For those who cannot have a downtime that is too long, we recommend the radiofrequency microneedle. We use the Endymed Intensif, which allows for highly customisable parameters, allowing us to individualise treatments to our patients’ needs. This treatment heats up the dermis to stimulate skin rejuvenation over the scarred areas.
STEP 4 - HydraDEP FACIAL
3 weeks after each Fractional CO2 laser session, patients will undergo the HydraDEP Facial to further promote healing from the laser and optimize results.