Author: Dr Branden Seow
There are various types of treatments for a whole range of acne scars. In this article, we shall explore more on this topic. There are 3 main types of acne scars that commonly appear after the active acne outbreak has resolve. They are pigment acne scars, atrophic acne scars as well as hypertrophic acne scars.
What are pigment acne 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.
What are atrophic and hypertrophic acne scars?
Atrophic scars are due to a lack of collagen remodelling that lead to depressions and uneven texture of the skin. In other words, such scars result in a loss of tissue. Atrophic scars can be further divided into boxcar, rolling and ice-pick scars.
Boxcar scars are broad depressions with sharply defined edges. Rolling scars are angular in shape with broad depressions and a sloping edge. Ice-pick scars are deep, narrow, and pitted scars.
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 such, the treatment for atrophic scar and hypertrophic scars differs.
Treatment for atrophic scar
In this segment, we will explore the various treatment modalities that The Clifford Clinic has that can help improve the scars.
Fractional CO2 laser
Fractional CO2 laser causes microscopic thermal injury to induce collagen production while sparing the surrounding healthy tissues. The skin will then start to repair itself and in the process of forming new collage, it will help to even out the scarring.
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 (INIFI RF)
Radiofrequency (RF) micro-needling is a treatment that has shown to have good improvement for patients with deep acne scars. INFINI Acne Scar Treatment 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. 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 excellent 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.
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. Submission is more suitable for rolling scars.
During the treatment, a hypodermic needle will first be inserted onto the skin under the scar. The needle is then moved back and forth in a “fanning” motion under the skin tissues to release the skin tissue, smoothening out the scar appearance.
At our clinic, subcision is usually combined with INIFI RF or filler, to achieve better improvement in scar appearance.
Dermal fillers fill up areas where there is loss in volume. The majority of 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.
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
Unlike atrophic scars, hypertrophic scars are not caused by a loss of tissue. Instead, hypertrophic scars develop because of an overproduction of collagen. 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.
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.
To address the types of acne scars you have and the optimal treatment plan for you, feel free to schedule an appointment with our aesthetic doctors!