Acne breakouts are unpleasant but the scars they leave behind can be more frustrating.These Scars are formed when a breakout penetrates the skin deeply and damages the deeper tissues. Each type of post acne scar responds to treatment differently, and some treatments are better for particular types than others. Post acne scars can be wide U shaped boxcar scars,narrow & deep V shaped scars called ice pick scars or wide depressions with rolled edges called rolling scars, atrophic scars which are flat, thin scars or depressed scars and some scars are hypertrophic and hyperpigmented scars.
The ice pick scars are very deep holes in the skin that look like the skin has been punctured with an ice pick. If the body produces too little collagen in response to an injury, depressed scars such as ice picks can form. Treatment may include excising the scar with a punch and suturing the defect closed, but this only works for isolated ice pick scars,If there are multiple ice pick scars, energy based devices that use radiofrequency energy can be used..These energy based device treatment help build collagen from the inside out, and collagen helps to fill the scars from within.
Energy-based skin resurfacing with a non ablative or ablative laser, radiofrequency, or an ultrasound device can help treat boxcar scars,as they all work by creating new collagen beneath the surface of the skin. Multiple treatments are likely to be needed based on the depth of scarring, Chemical peels can also help to a lesser extent. Along with these procedures, using a retinoid cream locally to increase cell turnover and further boost collagen can help to give better results. Fractional non-ablative lasers are the latest technologies, and they have less downtime than older lasers.The surgeon can be more aggressive and get results with fewer treatmens.Previous generation ablative lasers used to evaporate the skin's top layers, which requires longer to heal, but these newer non-ablative lasers like fractional erbium yag and erbium glass,pass through the skin's upper layers to safely heat the deeper tissues, stimulating collagen and smoothing the scar's appearance withless downtime. Microneedling is a another technique, which does not need surgery and uses application of mechanical force to the skin,through fine needles, to stimulate the proliferation of collagen cells under the skin. This lays down new collagen and elastin tissue, which improves the appearance of wrinkles, stretch and scar marks, pigmentation and other irregularities in the skin. It does improve the blood supply to the skin by formation of new capillaries. Chemical peels can also help to improve these scars to a lesser extent.
Rolling scars can be treated with microfat and nanofat injections followed by microneedling with platelet-rich plasma (PRP), Microneedling creates tiny wounds or pinpricks in the skin. The body's natural, controlled healing processis stimulated to boost the collagen production. Microneedling is also a very good acne scar treatment because it opens up channels within the skin that give PRP which has the healing factors in abundance. PRP is created by taking some of your blood, isolating the platelet-rich plasma, which contains proteins and other growth factors, and injecting it back into the scar.The objective is to build up the collagen layer under the depression in order to raise it to the level of the surrounding skin. You'll likely need multiple treatments, but the results are worth it. Treatment for hypertrophic and keloid scars focuses on reducing the height of the scar so the skin appears smoother.These scars need steroid injections,surgical removal or ablative laser like carbon dioxide laser.
The treatment acne scars with hyperpigmentation is with hydroquinone and sunblock creams. Hydroquinone is a topical bleaching agent that is applied directly to a dark spot. Sunblock is essential, since sun exposure can worsen hyperpigmentation. Other popular treatments include glycolic acid creams which remove the upper-most layer of the skin and the pigmented marks, and retinoids to increase skin cell turnover. You have to take all of these factors into account, and I always advise patients that multiple treatments will be needed, and even after a year or two, a 50 to 60 percent improvement may be expected.
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