SKIN PROBLEMS AND TREATMENT

5.2 Scars of Acne (Pimples): Treatment Methods

For effective treatment of acne scars one needs effective technologies and combination of techniques. Results depend on quality of technology, combination of techniques, repetition of treatments, type of scar, depth of the scar, quality of the skin and skill of surgeon. One should always keep optimum expectations and proper follow up. Be ready to undergo combination of techniques.

Multiple Methods of Acne-scar treatment:

1) Fractional CO2 laser skin resurfacing: It is Most chosen & best treatment. CO2 laser is available as Ultra-Pulse® fractional and Super Pulse fractional pixel. Choose Ultra-Pulse® fractional technology.DeepFXTM & SCAARFXTMare two technologies of Ultra-Pulse® fractional CO2 laser skin resurfacing. DeepFXTM & SCAARFXTM technology penetrate up to 4mm in theskin. Super-Pulse pixel/ Fractional CO2 laser penetrates only upto 1 mm of depth. So SCAARFXTM Ultra-Pulse® fractional CO2 laser technology should be used. Ultra-Pulse® fractional CO2 lasers are more effective than super pulse pixel/fractional. CO2 laser. It may be repeated two or three times in case of Ultra-Pulse® & 3 to 6 times in case of superpulse/pixel CO2 laser. Repetition is done if one wants more improvement with CO2 laser treatment. So Super-Pulse fractional/pixel CO2 laser is less commonly chosen for scar resurfacing.

2) Dermato surgical procedures: (a) Scar undermining, subcision, dermal/tissue grafting, fat grafting, filler injection. These methods often need repetition 2-3 times. These procedures provide additional results when used before or after laser skin resurfacing. Person should choose these methods when skin scars are of big sized or depth of the scar is more or scar is box type. (b) micro-needling (dermaroller), microneedling RF fractional technology, These technologies are somewhat less effective than Ultra-Plus® fractional CO2 but have their own advantage. These techniques need repeatation 4-6 times. Try to understand various technologies & their limitations. Costly technology is not advised in all cases. (c) Various Surgical treatment procedures for acne scar reduction e.g. deep scar excision, punch grafting etc. Scar Excision technique is use when scar is much deeper wider than 2mm. Punch grafting technique is used is box scar type scar is up to 2mm wide.(d) Dermabrasion: It is less commonly used. It is used when Ultra-Pulse® fractional CO2 laser, SCAARFXTM or other CO2 laser technologies are not available.

Tissue Grafting/ Tissue Transplant: To fill-up big depressed acne scars and other scars tissue grafting or tissue transplant is most effective method. It may need repetition after 6 months. Then one may undergo Ultra-Pulse® fractional CO2 laser skin resurfacing 1 to 3 times.C

3) Non-surgical Methods: (a) Non ablative laser facial skin rejuvenation on the scar: It improves the scar to certain limit. It improves darkness or dark spots, redness, thickness and rough appearance of the scar. Long pulse Nd:YAG laser, Pulse dye laser and Q-switch ND:YAG laser are used. It spot size is more depth of penetration is more. So results are better. Morepowerful laser machines can produces better results. This method is choosen in case of mild scars or adjuvant procedure after following surgical Scar excision preocedure to improve fine-ness of results. Q switch laser with top flat wave used for Laser facial skin rejuvenation produces better results than Q switch laser with Gaussean wave type laser. Q switch Nd: YAG laser machine with gaussean wave is cheaper but less effective technology as compared to flat wave Q switch Nd: YAG laser. In India, most of laser centers have less qualitative gaussean wave type Q switch Nd:YAG laser only few centers like us have flat wave beam laser machines later produces better results.

Use of long pulse Nd: YAG laser & Q switch Nd: YAG laser help in improving tone and texture of the skin without causing any damage to the surface of the skin. It can often be used after use of CO2 laser.

Non ablative laser skin rejuvenation/ laser facial rejuvenation/ Nd: YAG laser skin rejuvenation methods are good option to improve dark spots and texture of the skin. It is done in 3-10 sitting treatment.

(b) Crystal microdermabrasion/Diamond microdermabrasion-or skin polishing (mildly effective).

(C) Chemical Peels may help to some extent.One may need to repeat procedures 2 to 10 times for good improvement.

One may need to use combination of above 2 to 4 technologies to achieve better results. There are multiple technologies to treat acne scars Choice of above mentioned methods depend on number & severity of scars, financial budget, and available technology at treatment center, expected improvement by the patient etc.

Ultra-Pulse® fractional CO2 laser resurfacing: Ultra-Pulse® fractional CO2 laser resurfacing is best method & cost effective treatment among all methods of skin resurfacing in acne scar.

If small sub epidermal abscess, follicular abscess and cyst develops, it is punctured with CW CO2 laser. Then, margins are resurfaced.

Pitted ice pick scars are narrow and tracks deeper down. Box type scars have cut margin. Both of these types of acne scars are treated with scars excision method or sometimes withUltra-Pulse® fractional CO2 laseror by both techniques used combinely or in sequence.

Flat scar, stretched scars, depressed scars, atrophic scars, thin scars, hypertrophic scars, tunnels and bridges of acne scar tags are surgically excised first and Ultra-Pulse® fractional CO2 laser skin resurfacing is done in the sitting or next sitting.Ultra-Pulse® fractional CO2 laser can be used to smoothness the skin and to reduce marks of these scars looseness of the skin and wrinkles. If scar has elevation, it is flattened or leveled with. Ultra-Plus® fractional & non fractional CO2laser resurfacing. Shallow scars are blended with surrounding tissue. Super pulse pixel CO2laseris also available but it is less effective & need more sessions. As compared to true Ultra-Pulse® fractional CO2 laser is most safe as compared to other types of fractional CO2 lasers.

For superficial skin resurfacing active 'ActiveFXTM' mole of Ultra-Pulse® fractional CO2 laser skin resurfacing methods is used.For resurfacing at deeper level (e.g. acne, scars, aging) DeepFXTM and SCAARFXTM fractionalUltra-Pulse® fractional CO2 laser is used. CO2 Laser resurfacing treatment should be preferred.

Mild textural irregularities, macular lesion and mild superficial scarring improves with single or two passesUltra-Pulse® fractional CO2 laser with low fluence and least contact time.

For fine wrinkles / mild rhytides, Ultra-Pulse® fractional CO2 laser resurfacing single treatment is enough. For tough recalcitrant, post acne scar 1 to 3 sessions of Ultra-Pulse® fractional CO2 laser resurfacing are required. Each session of done at the gap of 4-6 months. More improvement is seen after each sitting. If super pulse fractional/ pixel CO2 laser is used often more number of resurfacing sessions are required (3 to 6 sessions) as compared to Ultra-Pulse® fractional CO2 laser resurfacing (1 to 3 sessions). Ultra-Pulse® fractional CO2 laser is more safe than super pulse pixel CO2 laser. Those who have more severe problem of acne scar or those who want better results need repeat session after 3-12 months. In exceptional cases on certain scars it is repeated after one month

Ultra-Pulse® fractional CO2 laser resurfacing is far superior to dermabrasion because it is without any bleeding. It helps to judge the depth of resurfacing and margins of even small depressed scar can be beveled. In addition, Ultra-Pulse® fractional CO2 laser also creates best collagen shrinkage among all above procedures. It can do wonder for skin of your face.

Laser's combination approach: AfterUse of Ultra-Pulse® fractional CO2 laser skin resurfacingflat wave beam Q switch Nd: YAG laser or L.P Nd: YAG laser facial skin rejuvenation is done to further improve fine-ness in skin texture, colour tone, scar quality etc.

Long pulse Nd: YAG Laser & IPL can reduce size of sebaceous gland & so secretions of sebaceous gland is reduced. Results aftercombination of

CO2 laser resurfacing treatment & Nd: YAG laser non-surgical laser facial rejuvenation treatment are far superior than microdermabrasion, ( skin polishing ) microneedling, chemical peels, electoparation etc. So cosmetic surgeon advisescombine use of these multiple methods with proper plan helps to give good improvement.

Combination of multiple Surgical Procedures: Treatment of acne scars depends on their size, depth, shape and duration and depigmented spots. a) Most of the scars can be managed with 2-3 treatment sitting of SCAARFXTM, DeepFXTM& ActiveTM , Ultra-Pulse® fractional CO2 laser skin resurfacing. Remaining parted scars can be managed by subcision, undermining, non-ablative laser skin rejuvenation. Width of the scar is reduced by replacing scar tissue of the skin with more vascular skin (punch graft). b) Filler injection/fat graft, dermal graft tissue is used for improving depth of the scar. One may be need 2-3 sittings of tissue grafting.

Deep broad acne scars or ce pick scars and pits: It may need elevation, punch excision and grafting: In case of major scar of acne, deep scar & ice pick like scar, the scar tissue is cut out and the wound is closed with suture (scar excision) or it is grafted with the skin (punch graft). Skin is taken from behind the ear for grafting. Suture mark slowly becomes invisible. Ablative laser skin resurfacing treatment can be done on the residual scar 2-5 times. The remaining deformity of scar can be improved further by 4 to 10 treatment sittings of laser skin rejuvenation treatment to improve fine-ness in results. Micro-needling (dermaroller), RF micro-needling can be used additionally to obtain further improvement. Tissue transplant or tissue grafting is well established medical procedure which improves scar appearance.

Undermining or subscision, tissue grafting or punch grafting then laser skin resurfacing &/or subsurfacing

In undermining or subscision skin over the depressed part of the scar is released from its underlying scar tissue and allowed to rise up. Then dermal grafting & fat grafting can be done. This may be repeated 2-4 times for better elevation and more formation of collagen. Then to treat residual part of scar of acne multiple modalities are used as per the need of patien. Ultra-Pulse® fractional DeepFXTM LASER skin resurfacing is most effective procedure among all of this procedure. Then one may undergo non-ablavive laser facial skin/scar rejuvenation with long pulse Nd:YAG laser Q-switch Nd:YAG laser or pulse dye laser or erbium YAG glass laser to improve quality and colour of skin.

Fat graft in scar: Fat can be grafted in the scar to improve appearance

During this treatment period patient should stay away from sunlight or strong artificial light or exposure to TV/Computer. All these procedures do not require any admission in hospital. Pigmentation may develops on the spot which can be treated easily.

During tissue transplant donar tissue is taken from under the skin and this tissue is grafted. Results are always good. In few cases it needs removal.

Microneedling/Dermaroller:

This techniques give results to some extent. It needs to be repeated 4-6 times at gap of 4-6 weeks. Those who have less financial budget, may choose this treatment.

RF microneedling:

In this technique microneedles enter under the skin & radiofrequency current is passed for collagen remodeling. At a time 50 -100 needles enter in the skin to procedure expected changes. Quality of results are less than Ultra-Pulse® fractional CO2 laser skin resurfacing.

Scar Excision:

Deep acne scars needs excision. After excision of such scar acnemay need CO2 laser resurfacing and non-ablative laser facial skin rejuvenation for better modulation of residual scar.

Do you know about non-medical cosmetic procedures?

Non-medical cosmetic procedures are less effective in comparison to medical treatment procedures. Less effective cosmetic care procedures are easily accepted by most of clients but these are often not able to create correction in cosmetic problem. Beware of persons who over promises and deliver less. Their procedures are sold as in very attractive packages & at higher cost. Effective medical cosmetic care & treatment products are sold in less attractive packages & at reasonable cost. They promise you less & deliver more under experts care.

Where other treatment does not work, laser treatment works.

IPL treatment:

IPL is not laser. Intense pulse light system (IPL) may be used for treatment of acne and acne scar. IPL is used for pigment removal of acne. Q switch Nd: YAG laser gives better results than IPL to remove pigment. In Indian skin IPL has more complication rates than Lasers. It is less safe in Indian skin.

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