Acne Scar Treatment

Post acne scars appear in various shapes and forms. You must have heard about box scars, ice pick scars, rolling scars, etc. These are mere descriptions of what we can see of these scars. Generally, we classify them into 2 types to makes things simple: Box scars and Pitted scars. Box scars have a broad base with sharp edges and the cross-section looks like a box. Pitted scars look like someone used the sword to jab into the flesh. There is almost no base, the cross-sectional diameter of the scar is very small and narrow, the opening is small as well – often mistakened to look like a large pore. But this is a very deep pore and in some cases go as deep as the entire skin thickeness. These two types of scars look very different and so it also makes sense that their treatment has to be different.

Box Scars

We have been doing subcision combined with Erbium YAG laser in thermal mode for the box scars for several years now. The concept is simple – with subcision, we introduce a fine needle under the skin to cut the fibrous roots that keep the scar stuck down. Then we use an ablative laser the Erbium YAG  laser to smoothen out the sharp edges and stimulate collagen synthesis resulting in the elevation of the scar. There is a reason why we chose to use thermal mode Er Yag laser instead of normal mode Er Yag laser. Normal ER Yag is a purely ablative laser, meaning it only burns the skin but has very little thermal heating that can stimulate collagen synthesis. What we need is both functions, ablative effects to smooth out the sharp edges of the scar (especially scars that came about after hard squeezing) as well as thermal heating to achieve new collagen synthesis and get the depth improvement of the scar. We can achieve about 70-80% improvement after several sessions. The main difficulty with this laser is that there would be scabs on all areas lasered that take 3-5 days to clear. This is significant downtime for several types of profession and so they would need to take leave.

Pitted Scars

These scars do not response very much to subcision as there is no base with fibrous roots to cut. Er Yag Laser provides some results but as the scars go very deep, its not the most effective laser. We need to use a different approach. We need to effect the transformation and collagen synthesis even at the deep layer of the skin. But we can’t burn the entire layer of the skin, that would be disastrous. Thus the only way to do it is to burn deep but in very small columns sparing healthy tissue in between. This is the concept of fractional laser. With this laser, there is also minimal downtime. The face is slight red for a couple of hours and then there is slight peeling for 3-4 days, nothing major so still able to go about routine work.

Am I a suitable Candidate?

Yes, most patients are suitable. However, if you have been on oral Isotretinin then you may need to wait for 2-3 months before you can do the treatments as these will affect natural healing and may results in new scar formation. If you have been sun tanning, then you need to wait for 1-2 weeks.

What does the treatment involve?

Topical anesthetic cream will be applied on the face for 20 mins. Then we will clean the areas with iodine before undergoing the subcision procedure. Lastly, the scar areas will undergo laser treatments. We can combine subcision with ER Yag laser or with Fractional Laser.

How long does the treatment take?

Each treatment takes 30-45 mins.

Is it Painful?

During the subcision and laser treatments, you will feel pain but it is tolerable. During the laser treatments, the use of cool air helps reduce the sensation of pain.

What happens immediately after the treatment?

After the treatment, your face will feel red and warm. Antibiotic cream will be applied on the areas and patients will be provided with the antibiotic cream to apply for the next 3-4 days. The ER Yag laser treated scars will grow darker immediately and a scab will form. For fractional laser , there would be almost no downtime.

What kind of effects can I expect after treatment?

Over the next 3-5 days, the scabs that form after on the Er Yag lasered areas will peel off in time. Please refrain from peeling it off earlier as the skin will recover on its own with time. After the scab falls off, the underlying skin will appear a little red and darker for 3-6 weeks. Patients do not need to worry, as this is part of the recovery process.