Lasers, lights and fillers are often used to treat acne scars.
For acne scarring, lasers and other energy-based devices have largely replaced earlier resurfacing techniques such as chemical peels and dermabrasion.
When choosing an acne scar treatment, look at what is known about the long-term safety and risks of each therapy.
Dermatologist and All About Acne member Dr Phillip Artemi says there is a range of ways acne scars form and several ways to deal with them.
Carbon dioxide or Erbium lasers are used on a variety of scars to carefully remove a controlled amount of the damaged outer layer of skin.
It can repair the surface layers and stimulate new collagen formation, which provides structure and strength to our skin.
Skin resurfacing can soften the scar, even out discolouration and produce a smoother and tighter skin appearance.
New treatments using ‘non-ablative’ (non-wounding) lasers to stimulate new collagen production do not damage the top layer of the skin and may be used for soft, indented scars.
Fractional laser treatment, also known as fractional resurfacing, is a treatment for improving skin texture and blending-in imperfections such as acne scarring.
Beams of laser light penetrate ‘pixel-fashion’ very deeply into the skin causing remodelling in all layers down to the depths of the scars. Treatment can be ‘ablative’ (wounding) where there is vapourisation of these pixels of tissue or ‘non-ablative’ where no wound is created.
You will need a series of treatments and there are side effects. Redness and swelling occurs for up to a week for the non-ablative treatment and longer for the ablative treatment. The full skin surface is not removed, unlike previous laser resurfacing techniques. Special ointments or skin care may be advised after the treatment to help with the healing.
Fractional laser treatment is usually conducted after an anaesthetic cream has been applied for quite some time (over an hour) or a local anaesthetic has been injected. Some treatments may require sedation.
Fractionated laser treatments may be called ‘ablative’ when it physically removes a column of affected tissue or ‘non-ablative’ when the laser injures the column of treated tissue, allowing it to repair and remodel without physically removing the tissue.
There are many different wavelengths that may be used for this purpose with the common theme being that the columns of damage must be deep enough to allow truly, deep dermal tissue repair and remodelling.
Much like the fractional laser treatments, radiofrequency can be used to treat acne-scarred skin.
Radiofrequency tends to have a similar ‘pixel’ effect on the surface of the skin but has a larger effect in the deeper layers of the skin. This may lead to a greater effect on the scars with less downtime compared with laser treatments.
Fractional radiofrequency may be delivered by just touching needles to the skin or inserting needles into the skin using insulated or non-insulated needles. The inserted needle fractional radiofrequency may allow a more focussed, deeper energy delivery.
Fractionated heat is also being used in a similar way to fractionated lasers and radiofrequency to selectively wound the skin and initiate repair which produces a superior skin quality than that at baseline.
Photodynamic therapy or PDT is mostly used for treating superficial skin cancers and precancerous lesions, but it may also be used for treating acne and some inflammatory skin conditions.
After a microdermabrasion treatment, which removes cell build-up from the skin’s surface, a special solution or cream containing aminolevulinic acid (ALA) – an amino acid, a building block of protein – is applied to the skin for an hour or longer. This is taken up more readily by the inflammatory cells and oil-producing glands and makes them more sensitive to light.
After this incubation time, light is applied to the area. This is usually a continuous blue or red light but may be an intense pulsed light or a laser. Because the acne areas will have taken up the ALA more than the normal skin, they will be selectively treated. These areas usually flare up for a week or so and then settle. You will usually need a series of treatments.
The normal skin surrounding the acne areas becomes sensitive to light for the following two days. Bright light needs to be kept off the area during this time, which usually means staying indoors and keeping away from TV, computer screens and windows where the sun shines in.
This procedure is quite expensive so it’s not usually considered as a first option.
This is a treatment that gives the skin a ‘cut, polish and vacuum clean’. It has a superficial buffing effect, which smooths the surface and the suction cleans out comedones and pustules which are the lumps and bumps on the skin. You will usually need a series of treatments.
For acne, microdermabrasion is not regarded as a stand-alone treatment but may be used in association with topical or oral medications. If used alone for repeated sessions, it can make acne worse for some people with sensitive skin.
Microdermabrasion would only be considered for the most minor acne scarring conditions.
Indented scars can be plumped out with commercial products injected into the skin. Hyaluronic acid (e.g. Restylane, Juvederm, Esthelis) has replaced collagen because of its longer lasting benefits.
They are accurate, simple and effective techniques, however they do not result in a permanent improvement and may have to be repeated or touched up. That said, they are surprisingly long term and make up for any negatives by their accuracy and instantaneous effects.
Fat cells and tissue grafts can also be transferred from another part of the body.
Raised and thickened scars can be softened and flattened using steroids either applied to the surface of the skin or injected into the scar. Fluorouracil (a cancer medicine) has been successfully used to flatten scars by being injected into the scar.
Deep “punched out” scars can be cut out and closed side to side with stitches, while large raised scars may be improved by surgically removing them. Surgery may be performed prior to laser resurfacing which can sometimes help blend in and hide the surgical scars.
Subcision or freeing-up an indented scar is a valuable procedure when the scar is bound down to underlying tissues. Other so-called ‘punch’ techniques include punch grafts – where a small graft is used to replace the scar, or punch elevation – where the scar is punched and lifted up to a higher position in the skin.
When acne makes it difficult for you to enjoy your life, it’s definitely time to see a doctor.