Acne Scars: Why They Linger and What You Can Do About Them
This blog post was written by Dr. Jason in 2019.
Acne scars occurs as a result of a full thickness injury to the skin from inflammatory lesions such as acne, most notably would be nodulocystic acne. This injury involves the dermis layer of the skin.
In the attempt to repair the damaged skin, scar tissue and collagen is formed in an irregular pattern around the injury that leads to the appearance of acne scars and these can become permanent.
The worst part is, the bigger and deeper the acne is, the more likely scarring is going to occur. They are different from post-inflammatory pigmentation (hypo, hyperpigmentation, erythema), acne marks or blemishes which can be temporary and can be resolve with time on its own.
There are many different types of acne scars such as, ice pick, rolling, box, atrophic and hypertrophic.
Dr Jason's DEKA Training Diary
In this entry, I will be sharing about the DEKA training held in Florence, Italy on 20th and 21st May 2019.
Some of you would already be familiar with CO2 lasers in the treatment of acne scars and removal of skin tags and milia seeds. But with so many CO2 laser machines in the market, it can be confusing for the consumer and most of the time it is left to the physician to make the decision.
This article aims to explain some of the important parameters that us physicians use and adjust in order to achieve the intended outcomes.
First, a short description of the product. The SmartXide Punto is a CO2 laser (wavelength 10,600nm). This wavelength is selectively absorbed by water in tissue.
The main uses of the SmartXide Punto CO2 laser include;
Vaporization – used in the treatment of skin tags, warts, seborrheic keratosis (a form of pigmentation), moles, oil seeds (milia), syringomas etc. and
Stimulation – whereby collagen remodelling, stimulation, and rejuvenation is used in the treatment of acne scarring and skin laxity
Incision – a cutting mode used more in a surgical setting, such as for double eye-lid (blepharoplasty) creation
Every laser machine comes with a set of parameters that can be adjusted, depending on its intended purpose and application. The SmartXide Punto comes with 2 main handpieces, the freehand and scanning handpieces.
The scanning handpiece is used primarily for stimulation, while the freehand hand piece is used primarily for vaporisation and incision.
A look into the training!
On the first day of the training, we were greeted warmly by the DEKA rep and introduced to Prof. Paolo Bonan, MD.
The next couple of hours were spent going through the theory and presentation of the DEKA Co2 laser. Prof Bonan also shared with us his clinical before/after photos, demonstrating to us the diversity of conditions the DEKA Co2 machine could treat.
During his lecture, Prof Bonan also explained to us how the DEKA Co2 machine gave operators the ability to be in control of every laser parameter, and how this translated into better treatment outcomes and results, as well as a lower risk of side effects and complications.
After lunch, it was time for demonstration and hands-on practice. The hospital had arranged for a few subjects already, and after getting them prepared and numbed, Prof Bonan started with his demonstration. We had a productive discussion with Prof. Bonan about his choice of settings and parameters, and how we could adapt this to the Asian population. Then it was our turn to try out the machine for ourselves.
On the next day of the training, the focus was on a different machine, the DEKA Onda. This machine uses microwave technology to heat up and break down fat. It has also been proven to improve cellulite and skin laxity, making it the only machine that can achieve these 3 functions in a single treatment.
After the lectures, we were guided along how to use and adjust the parameters of the machine, before having our own hands-on demonstration. We were then transferred to visit the DEKA Factory. In this facility, the machines are produced, assembled, and tested rigorously. A representative walked us through the facility and explained to us the various sections and functions of the facility. No photos and videos allowed in the facility apart from their machine range showcase.
Although our training focused on the DEKA CO2 and DEKA Onda machine, the DEKA brand does have a range of other products as well.
At Astute, we can help to resolve your acne scar problems!
Astute's Ultimate Acne Scar Removal Programme
5 Different Modalities for treatment of Acne Scars
Subcision for Tethered Scars
Many treatment plans of Acne Scars begin with subcision for tethered scars. These are scars that are stuck down to the deeper layers by fibrotic tissue, causing a depression.
Our doctors can loosen or break up these scar tissue using a blunt instrument or a fine needle. The mechanical movement under the skin also stimulates collagen production, restoring some volume to the scarred skin.
Co2 Fractional Laser Resurfacing
We follow up with a second treatment at least 6 weeks later. When the scars have improved after subcision, we can consider the use of energy-based devices.
The Fractional CO2 Laser is one such device. Fractional lasers use targeted high-energy lights to create micro-columns of injury in the skin. Areas of the skin are spared, allowing a faster recovery time and lower complication rate compared to traditional full ablative lasers. The selective damage to the skin caused by the laser allows the skin to remodel itself, improving the appearance of the acne scars over time.
Fractional Laser resurfacing works well for rolling scars, enlarged pores, box car scars, and moderately well on deeper, ice pick scars.
The downtime for Fractional CO2 laser ranges from half a week to 2 weeks, depending on the intensity of the treatment.
RF Micro Needle
If the downtime of the CO2 laser is an issue, the Radiofrequency Micro Needle can be considered. This technology utilises a series of needles to deliver radiofrequency energy into the dermis layer skin where it is needed. The selective damage stimulates remodelling and collagen production in the scarred areas that have been damaged by inflammatory acne while sparing the epidermis. As a result, there is lesser downtime compared to the CO2 laser.
Pico Fractional Laser
We are also able to utilise the fractional picosecond laser for treatment of acne scars. Like the Radiofrequency Micro Needle, this treatment is suitable for those who cannot afford the longer downtime associated with the more aggressive fractional CO2 laser resurfacing. It utilises a special lens to concentrate light energy deep in the skin, breaking up scar tissue in the process and encouraging remodelling where it is needed.
TCA Cross
Finally, there is the TCA CROSS (chemical reconstruction of skin scars).
This is a tried and tested method for treating deep scars such as ice-pick scars and deeper box car scars. It utilises a medium to strong chemical peel (usually 70% to 100% TCA) to damage the bottom of the scars that cannot be reached with lasers. TCA CROSS is a manually intensive procedure requires skill and precision.
There are different types of acne scars. Proper diagnosis is very important. Treatment must be individualised as different scars require different types of treatments for success.
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