Acne scars not only the skin. It also damages self- confidence and reduces sense of wellbeing. Unfortunately, despite many recent advances in the treatment of acne, acne scarring still remains one of the most common causes of facial scarring.
Though acne scarring is happily no longer a problem without a solution, it is important to understand that there is still no “one size fits all” solution, that no single treatment can correct every acne scar. This is because acne scarring comes in a variety of shapes, sizes and degrees of severity and each type of scar responds best to a particular treatment.
As many people with acne scarring have a combination of different scar types, best outcomes are sometimes achieved only by using a combination of targeted treatments. Treatment options for acne scarring include lasers, dermal fillers, TCA Cross, subcision, skin needling, cortisone injections, microdermabrasion, punch excision and surgery.
It is also important to be realistic about acne scarring treatments. Expectations of 30-70% improvement after a course of treatments are realistic. Expectations of 100% eradication are not, as the reality is that many scars can’t be completely erased.
Laser Treatment of Acne Scarring.
Laser treatments for acne scarring fall into two categories – those that improve the colour of the scars and those that smooth the surface of the skin and.
- Colour improving lasers: Persistently red scars can be improved using a vascular laser. Usually a short course of treatments spaced at monthly intervals is sufficient to achieve good reduction of colour in red scars.
- Skin smoothing lasers: 1. The current gold standard laser for acne scarring is the Fraxel laser. The Fraxel represents a major break-through in the treatment of acne scarring and is an effective solution for some types of scars. Fraxel technology represents a safe, low downtime alternative to older, more aggressive laser treatments, such as carbon dioxide laser resurfacing which, though often effective, also exposed the skin to significantly more risk of long term complications.2. The Erbium laser resurfaces the scarred area to a precise depth by removing the upper layers of the skin. This results in gradual remodelling and smoothing over a course of treatments. Unlike the Fraxel that treats only a “fraction” of the skin at any one time, the Erbium resurfaces 100% at each treatment, which means results accrue faster, but involve more downtime.
1. Fraxel lasering for Acne Scarring
Fraxel treatment uses a simple principle of creating thousands of microscopic channels of energy in the skin. (See illustration) These channels are each only the diameter of a shaft of hair, but extend deeply into the middle layer of the skin where scars lie. Your skin interprets Fraxel energy channels as” injuries” or “wounds” and immediately switches on its repair enzymes that begin producing new collagen. Fresh, new collagen remodels the skin more evenly and this has the effect of smoothing out the clumps and irregularities of collagen that exist in acne-scarred skin.
Fraxel stimulates your body’s own natural healing process, encouraging it to replace old scarred skin with smoother, fresher, glowingly healthy skin. Fraxel technology allows us to achieve better results with far fewer complications than with traditional treatments for acne scarring. The bridges of normal skin cells surrounding each tiny channel of treatment mean healing occurs rapidly over the first 24 hours and risk is reduced. Results accrue over a course of treatments.
Which types of acne scars do best with Fraxel laser?
Superficial scarring. Deeply pitted or ice pick scars are best managed using alternative treatments.
How many treatments will I need?
Results accrue over a course of treatments, the exact number of which depends on the depth and extent of your acne scarring. Typically a series of 3- 5 of more Fraxel laser treatments are recommended for scarring at 2-3 monthly intervals. This time frame allows for complete healing and for the production of new collagen and elastin to replace damaged tissue.
What does treatment involve?
The area is first anaesthetised using a numbing cream and a stream of cold air is used throughout your treatment to further improve anaesthesia. Eye shields are worn throughout the procedure, during which a computer guided scanner directs the laser light to the areas to be treated. Full face treatments take about 30 minutes
How do I prepare for Fraxel?
For 2 weeks before your treatment, do not use active skin care products containing any of the following: retinol, glycolic acid or salicylic acid. Do not tan, either naturally or artificially. Do not have any other laser or microdermabrasion treatments in the area to be treated and do not wax or use abrasive scrubs. Do not have any dermal filler treatments during the month before Fraxel. Remember to come in at least an hour before your appointment for numbing cream.
What should I expect after treatment?
Depending on the intensity of your treatment, you may experience redness and/or swelling which diminishes as quickly as the next day or over the next several days. Surface pigmentation will darken, then shed about day 4. As with sunburn, your skin will flake and exfoliate normally, revealing fresher, glowing and smoother looking skin..
How do I look after my skin after treatment?
When do results appear and how long do they last?
Because Fraxel treats both the surface and deeper layers of your skin, results are both immediate and progressive. Soon after the treatment the surface of your skin will feel softer and smoother, look brighter and show a more even tone. The next 3 to 6 months will bring more improvement as the deeper layers of the skin continue to create new collagen. Results are long lasting and can be further improved by ongoing use of active skin care at home.
Does a Fraxel treatment hurt?
Most patients describe an increased sensation of heat during the treatment. To minimize discomfort, topical anaesthesia is applied before the procedure and cold air is applied to the treatment area during the procedure. After the treatment, most patients feel like they have a sunburn, which usually diminishes in 1 to 3 hours
Is there anyone who shouldn’t have Fraxel?
Yes. Fraxel is not recommended if you’ve taken Roaccutane within the preceding 12 months, if you are pregnant, have a history of bleeding disorders or vitiligo, or have active infections in the area to be treated on the day of your treatment. Optimum results depend upon your body’s capacity to manufacture new collagen. Smokers should be aware that smoking compromises this ability and results may fall short of those achieved by non smokers.
Is Fraxel safe?
Fraxel’s safety record is backed by extensive research. Of course, as with any laser procedure there are always some risks and/or downtime. Your clinician will discuss these issues with you during your consultation.
What are the risks?
Fraxel treatment is well tolerated and side effects are minimal. Nevertheless, potential risks include prolonged redness or swelling, infection, pigmentation changes (either darker or lighter), scarring, activation of pre-existing herpes (cold sore) infection and acne flare ups. Patients prone to cold sores may need to commence antiviral medication prior to treatment.
Please let us know if any of the following apply to you. Precautions may be needed if you are taking anticoagulants to thin the blood or medication that makes you sun sensitive, have a history of keloid or abnormal scarring, are an uncontrolled diabetic in whom healing may be compromised, are immune suppressed or have a connective tissue disease.
• Full face $995 or course of 3 $2650
• Cheeks $500
2. Erbium lasering for Acne Scarring
Resurfacing is the most invasive of the acne scarring laser treatments, delivering substantial results in fewer treatments but with more associated downtime. Resurfacing aims to smooth the skin but planning down successive layers until a satisfactory smoothness is achieved. Erbium lasering may be full face or limited to affected areas. Erbium laser treatment is performed under local anaesthetic, with or without light sedation. Usually one to two treatments are required, several months apart. Immediately following treatment, your skin will be red and weepy. Healing occurs over 7 to 10 days and the treated area may remain pinker than normal for one or more weeks, during which time makeup or a tinted sunscreen can be applied. Improvement continues for up to six months. 30-70% reduction of scarring can be expected.
Medicare rebates may apply for erbium laser resurfacing of acne scarring. Rebates from exceeding the Medicare safety net may also apply.
Alternative treatments such as skin needling will be discussed with you at your consultation.
What’s my next step?
Call 02 9552 6277 or email us to firstname.lastname@example.org to arrange a consultation with one of our doctors who can recommend the best treatment for your particular types of scarring.