Acne Scars: 3 Types Of Scars And The Recommended Treatments
Acne scars treatment
Acne scars are troubling to many people. They can potentially affect self-esteem, and cause anxiety or even depression. Acne scars can therefore be potentially very distressing. Acne scars present themselves as an aftermath from an acne outbreak. When acne breakouts happen, the acne outbreaks cause damage to the skin and tissue beneath it. As the acne recovers, the body will try to repair this damage. In the process of healing, the body produces collagen. When the body produces too little or too much collagen, a depressed or raised scar will form respectively. Therefore, the type of scar depends on how much collagen your body makes. How well the body heals the skin damage and whether the healing forms a scar is largely dependent on genetic factors.
Acne scars can be largely classified into three types: atrophic scars, hypertrophic scars, and “colour” scars.
Atrophic scars – These scars form when there is a lack of collagen in repairing the skin. As such, the scars appear depressed, otherwise also known as atrophic. The atrophic scars can present themselves as either ice-pick scars, rolling scars or boxcar scars.
Hypertrophic scars – These scars appear raised, and they protrude from the surface of the skin. They are the result of excess collagen growth in the area where the acne lesion happened. Hypertrophic scars appear within the same region that the acne used to be in, while keloid scars grow beyond the margins of where the acne lesion was.
“Colour scars” – These pigments typically form after the acne has gone away. These “colour scars” typically appear as black or brown or red. The black/brown spots are known as post-inflammatory hyperpigmentation. They happen due to an increase in melanin production after the skin is injured or irritated. The red spots are also known as post-inflammatory erythema. They are caused by dilation, inflammation, or damage to the small blood vessels known as capillaries that reside under skin.
This article will delve deeper to understand the various treatment modalities for each scar type at The Clifford Clinic. The Clifford Clinic has a plethora of technologies and services that can help to get rid of acne scars in Singapore, no matter the scar type that you have.
Treatment for atrophic scar
Atrophic scars happen when there is net loss of skin tissue due to reduced collagen production to repair the skin after the acne outbreak. They are classified as boxcar scars, rolling scars and ice-pick scars. These are a few distinguishing features of each type of atrophic scar.
Boxcar scars: They have broad depressions with sharply defined edges. The scars are usually round to rectangular depressions with a well-demarcated vertical edge.
Rolling scars: They are angular in shape with broad depressions and a sloping edge. Rolling acne scars are due to scar bands extending from the dermis to the subcutaneous tissue resulting in dimpling of the skin, giving the rolling appearance.
Ice-pick scars: They present as deep, narrow, and pitted scars.
For treating atrophic scars, ablative laser treatments like fractional CO2 or microneedling technologies are generally recommended at The Clifford Clinic. The goal of these treatments is to achieve improvement in scar appearance by stimulating collogen production, making scars appear shallower and not as deep as before, therefore improving the texture of the skin. Dermal fillers are also a potential option to replace volume that is lost for certain atrophic acne scars.
Fractional CO2 laser:
The Edge Fractional CO2 Laser functions by causing precise and controlled thermal damage to targeted treatment areas by heating up the dermis with a laser beam. The laser causes microscopic thermal injury to induce collagen production while sparing the surrounding healthy tissues. Applying controlled thermal damage causes the body to respond by producing repair signals to aid in the repair of the damaged tissue, triggering the body’s natural repair system and collagen regeneration. The skin will then start to repair itself and in the process of forming new collage, it will help to even out the scarring, achieving better texture of the skin.
The treatment can be done in just 30-60 minutes (including the application of local anaesthesia) and completed over 5-10 sessions for best results, depending on the initial severity of the acne scars. Treatment is largely tolerable for most patients. Some redness or swelling after the treatment is expected and will usually subside within the first week. Since fractional CO2 laser is a highly customizable treatment, our doctors can personalize treatment parameters according to your skin type and condition. Besides treating depressed, atrophic acne scar, fractional CO2 laser can also help treat enlarged pores, uneven skin texture and promote overall skin rejuvenation in the process!
Radiofrequency (RF) micro-needling:
Micro-needling has better a popular option to treat acne scars. It entails the usage of a sterile rolling device with several fine sharp needles on it and the device is applied sequentially to acne scars to create multiple small micro punctures in the papillary to mid-dermis layer of the skin. By creating these micro-injuries in the skin, the body will produce a cascade of growth factors that will lead to collagen stimulation and production.
INFINI RF is a brand of radiofrequency micro-needling technology. INIFINI RF is an FDA-approved RF micro-needling treatment that penetrates up to 3.5mm into the skin, as compared to up to 1.5mm for fractional CO2 lasers. INIFINI RF uses micro-needles to penetrate and as well as to precisely deliver radio frequency (RF) energy deep into targeted tissue to stimulate collogen production and restructure the surrounding skin.
By delivering multiple passes at different depths in the skin, we can maximize collagen remodelling in the skin, thus smoothening out acne scars as well as potentially tightening the skin.
INFINI RF treatment provides great results for deep, boxcar and rolling scars. The entire treatment takes roughly 20 minutes to complete, and patients will need anywhere from 2-8 treatment sessions at intervals of 4-6 weeks, depending on the severity of scarring. The downtime required is about 3-5 days.
The Clifford Clinic also houses another brand of micro-needling technology, known as the Secret RF. The main difference between Secret RF and INIFNI is the type of micro-needles used for each device. INFINI uses insulated micro-needles, while Secret RF uses non-insulated micro-needles. This means that the RF energy is concentrated at the tip of the micro-needles for INIFNI while the RF energy is distributed along the length of the micro-needles for Secret RF. Therefore, INFINI requires multiple passes to the skin while Secret RF requires one pass to the skin.
Both treatments are effective and similar in its method for encouraging collagen production and treating depressed acne scars. In our experience, scars that do not respond well to Secret RF usually responds better to INFINI, and vice versa. As such, we advise a consultation with our doctors to assess the skin condition first to determine which is preferred. Patients also respond well to both SECRET RF and INIFINI treatment protocol, spaced at specific time interval.
Subcision:
Subcision is a procedure that involves using a small needle to get underneath the scar to manually break down the tight collagen bands that are attached to the skin. The needle is positioned in a horizontal plane in the upper subcutaneous tissue and moved in a gentle back and forth motion (like a fanning motion) parallel to the skin to release the fibrous bands. Once released, the skin will be able to achieve a smoother appearance. Submission is more suitable for rolling scars as rolling scars appear due to these fibrous bands pulling onto the skin, causing the rolling appearance.
At the same time, subcision can also cause subdermal bleeding, and the formed blood clot creates a potential space in the tissue to elevate the skin within the scar tissue. Thus, when the skin heals, new collagen can be formed in a plane that is more even with the surface of the surrounding skin.
At The Clifford Clinic, subcision is usually combined with INIFI RF or filler, to achieve better improvement in scar appearance. Usually, several treatments are necessary. Potential side effects include temporary swelling and bruising, and rarely skin nodule formation.
Dermal Fillers:
Dermal fillers fill up areas where there is loss in volume. Many dermal fillers are primarily made up of hyaluronic acid (HA) that are used to fill up volume loss in facial areas due to aging. In the case of atrophic acne scars, fillers help to elevate the scar tissues and therefore evening out the appearance of the skin to be like surrounding skin. Fillers usually work well with superficial boxcar scar. Some of these fillers also have the properties of stimulating collagen production in the area of insertion, thereby further improving the skin texture when it comes to treatment of acne scars.
As most dermal fillers do not last forever, patients will have to return to get maintenance treatments at regular intervals, usually every 1-2 years. Regardless, dermal fillers are ideal for shallower atrophic scars that can also be combined with INFINI RF, subcision or fractional CO2 laser!
Treatment for hypertrophic scar
Hypertrophic scars are thick raised scar that are formed due to an abnormal response to wound healing. The difference between hypertrophic scars and atrophic scars is that hypertrophic scar results from excessive collagen formed, giving the appearance of a lumpy scar on skin, while atrophic scar result from a net loss of skin tissue, giving the depressed scar that can appear in various forms, as described in the previous section of the article. Hypertrophic scars are firm, raised scars that grow above the surface of the skin but contained within the area of skin damage. Keloids are also a type of raised scar, but they grow larger and wider than the area of skin damage. Both hypertrophic scar and keloid scar represent abnormal responses to dermal injury, with excessive deposition of collagen production. The treatments for keloids and hypertrophic scars are similar, but hypertrophic scars have a better prognosis in general.
Patients who are at higher risk of keloids are usually younger than 30 years and have darker skin tone. Besides the cheeks where acne usually forms, other areas of hypertrophic scars or keloids growth include the sternal skin, shoulders and upper arms and earlobes.
There are various ways to treat acne hypertrophic and keloid scars. They may include steroid injection, silicone gels, pulsed dye laser treatments (V-beam) or even surgical excision. There can be improvement with treatments. However, the potential for recurrence of hypertrophic scar is always there, even after surgery.
Steroid injections can help in the prevention and treatment of keloids and hypertrophic scars. Corticosteroids suppress inflammation and mitosis (cell replication) while increasing vasoconstriction (reducing blood supply) in the scar. As such, this limits the scar to increase in size as well as to shrink the scar. Potential side effects include thinning of the skin and hypopigmentation.
Silicone sheeting is a non-invasive and well-studied method in the treatment of keloids and hypertrophic scars. Silicone sheets are believed to work by increasing the temperature, hydration, and perhaps the oxygen tension of the occluded scar, causing it to soften and flatten. Silicone treatment can come in the form of silicone sheets, strips, gels, sprays, and foams.
Treatment of keloids with short-pulsed, 585-nm pulsed dye laser (V-beam) has shown promise in improving hypertrophic/keloid scars. The main effect of a pulsed dye laser is on scar microvasculature, reducing redness and itchiness and improving skin texture.
Treatment for “colour scars”
This is one of the most common medical concerns that patients have when they come to The Clifford Clinic. After a course of medical treatment for active acne, and the acne resolves, it is very common for those acne spots to leave coloured marks. They are usually brown/black or red in colour. The brown/black pigments are called post-inflammatory hyperimentation (PIH) while the red pigments are called post-inflammatory erythema (PIE). Some patients have more of one colour than the other, while some have both colours in equal proportion. For some patients, the pigments can clear up by themselves very fast. While for some other patients, the pigments do not clear as much. So, despite having controlled the acne outbreak with medications, patients can still feel frustrated as they are still no way near to their original clear skin.
To treat PIH and PIE, at The Clifford Clinic, we recommend Q-switch and V-beam respectively. Q-switch targets brown and dark pigments while V-beam targets red pigments better. Both lasers can be done in the same setting, one after the other. There is almost no downtime for either laser. Urticaria (hives) can also occur occasionally, though this can be treated with medications. No pre-laser numbing cream is required unless the patient requests for it. For more information on the acne laser treatment cost in Singapore, do not hesitate to contact us at The Clifford Clinic.
In conclusion, there are various ways we can address acne scars with the relevant acne scar treatments in Singapore. You may feel overwhelmed by the information presented in this article. Fret not! Feel free to make an appointment with us for an evaluation and our doctors can tailor a treatment plan to address your specific concerns!