Once acne has cleared it oftentimes leaves conspicuous scars that cause embarrassment and emotional distress. Scars happen because the inflammation of acne lesions damage the collagen and elastic structure of healthy skin. This is made worse by picking or popping lesions or failing to treat acne in a timely manner.
Luckily, there are many treatment options to return skin to its former glory. Below are some of the most common and effective.
Microdermabrasion is a mechanical treatment that manually resurfaces skin uses one of two techniques. Either aluminum crystals are blasted onto skin or a diamond coated end piece polish the outer layers of the dermis to smooth out skin imperfections. Suction is also used simultaneously to remove dead skin debris, oil and environmental dirt.
This process treats acne scars in a way that is more complicated than it seems. It would seem that buffing acne scarred skin would work from the outside in, but that isn’t the full story.
Actually, deep exfoliation like microdermabrasion sheds the outer layers of skin so that it can be replaced by new skin from the inside out. This process of exfoliation is called desquamation and triggers skin to produce glycosaminoglycans, otherwise known as GAGS, that are responsible for producing new collagen. So what happens is that old, scarred skin is buffed away so that the body can produce new collagen that is healthy and without scars. A plus is that there is no downtime, side effects are minimal and include temporary redness and in some cases mild redness. It is not unheard of to get a microdermabrasion treatment during a lunch hour and return straight to work. Chances are that no one will even notice you’ve had a procedure. The process is virtually painless though some people report a slight tugging, scraping and /or burning sensation. Numbing cream is provided in some circumstances but generally not needed.
To get the most effective results one would need at least six to eight treatments spaced two to three weeks apart (to give the skin time to heal). This can be costly and time consuming but the good news is that prices are dropping all the time due to new treatments being introduced into the skincare market.
Microdermabrasion is most effective for mild scars because it cannot go deep enough to treat severe scarring. There will not be miraculous results for scars that are deep or pitted or hypertrophic. In such cases, microdermabrasion would need to be combined with other treatment methods for best results.
In addition, broad spectrum sunscreen of 30 or more must be worn at all times during treatment when exposed to UV rays or scars may get worse.
Microneedling is perhaps one of the most effective treatments for acne scarring currently available. It is performed with a handheld device equipped with detachable needle covered end-pieces that are replaced with each use.
During treatment, the needles vibrate in and out of skin to create micro-wounds and pinpoint bleeding. This causes the body to begin an immune response to repair the micro-wounds and promote collagen that produces renewed skin. It works better than microdermabrasion because it goes deeper and intense and causes an immune response. Yet it is still less invasive than laser or other treatments.
Results can be seen even after one treatment but the number of treatments needed depends on the severity of the scars. Typical treatments consist of one to six sessions spaced four weeks apart for optimal healing time. Even after your last treatment you will notice continuing improvement in skin texture in the weeks following.
Microneedling is a bit more painful than microdermabrasion, so some opt for the numbing cream. The face does bleed in pinpoints but it looks much worse than it is. Numbing cream is not necessary in most cases as patients report mild burning and stinging that is bearable. Besides, numbing cream tends to irritate skin by causing itching, swelling and redness so most people find that it isn’t worth it.
I’ve seen significant improvement in those who have had only one treatment of microneedling and drastic improvements for those who follow through with the entire regimen of six sessions.
IPL Intense Pulsed Light- Polychromatic Light Treatment
Intense Pulsed Light (IPL), otherwise known as a photofacial, is not technically a laser treatment though it is commonly referred to as such in skincare industry. This is because it works in much the same way that laser treatments do. IPL machines shoot polychromatic (rather than chromatic as with other lasers) light into the deeper layers of the skin and bypass the upper layers, heating it up and targeting unwanted imperfections. The heat and light creates collagen production which reboots new skin production.
Treatment consists of one to six sessions depending on severity of scars. Slight discomfort that is similar to a mild zap of heat is usually felt. To combat this, frigid air is blown onto the skin as the heated IPL tip passes over each area. As an acne scar treatment, IPL is one of the weaker options except for post-inflammatory-hyperpigmentation scars (or scars that are not pitted or raised, but merely discolored.). Following through with the full six sessions will result in wonderful PIH scar improvements but severe scars will need other treatments in conjunction with IPL. The price point is very affordable for one treatment, ranging from $100$-$200, but following through with the full number of treatments can get pricey.
I’ve had many IPL treatments combined with microdermabrasion and have seen impressive results. No one would ever guess that I used to suffer with significant acne. Though my scars were never severe.
Fractional C02 Laser Resurfacing
This is perhaps the most drastic and invasive treatment for acne scars available, but it is the most effective. C02 is an ablative laser, meaning that it actually removes skin tissue. In this way it can destroy benign lesions of the skin such as acne scars. The face is wounded but healthier, unscarred skin grows to replace the skin that has been ablated. C02 also goes beneath the surface and works on the collagen-elastin matrix below.
C02 lasers are now fractionalized, which means the beam of light is broken into thousands of tiny fragments and is therefore less damaging than one single, strong beam. This makes the healing process quicker. Only one or two treatments is needed and aftercare is just as important as the treatment. SPF must be worn at all times during exposure to sun and in fact it is best to avoid sun altogether for at least a week. One must not wash their face for at least one or two days following treatment or wear makeup for a week. Gentle face wash and a moisturizer should be used following two days after treatment. The skin should be babied. Ice packs, avoidance of heat, and post laser treatment creams (available from providers) should be used. This procedure is costly, ranging from two to three thousand for just one session, but if you’re looking for an ultimate fix, this is it. Skin will scab, swell and turn red. The scabs will flake and eventually fall off within 7-14 days. If you plan on going to an important event during the weeks following this procedure, it is not a good idea. One of my old bosses had this procedure done and went to a family dinner. She said she felt like a monster as part of her face kept falling off into her soup.
Chemical peels are facial treatments that use natural acids to penetrate the deep layers of the skin to stimulate skin repair. At the same time, they work on the surface by peeling away the superficial layers of skin so that new skin can replace old. The most common peels performed to treat acne scars are glycolic acid (derived from sugarcane), TCA (trichloroacetic acid), lactic acid (derived from sour milk), and Jessner peels (a combination of lactic, salicylic, and resorcinol acids in an ethyl base.) These acids contain a relatively small molecule size, which means they can penetrate the skin easily. They are also much more acidic than the skin, which aids in the peeling process.
A chemical peel can be thought of as a controlled wound. The intentional wound caused by the peel amps up the body’s immune system to heal the area to a state that was better than before.
The skin is cleansed and then prepped with a solution to degrease the surface so that the peel will penetrate optimally. The peel mixture is then lightly brushed onto the skin and left for only a few minutes so that it will not cause damage. In some cases, the peel is applied more than once or massaged in, but that depends on the sensitivity level of the one being treated. There will be discomfort, burning and stinging, but it should not feel terrible. If the peel begins to feel too hot, it should be removed right away with cold towels that have been soaking in ice-water. The cold water neutralizes the acid and starts the healing process. The skin is then treated with a PH balancer to bring it back to it’s normal PH and slathered in SPF. As is always the case, SPF is vital in the next few weeks following treatment.
Chemical peels, especially TCA’s are very effective for acne scarring. Several treatments will be needed, however and that can be costly. Usually if purchased in a package, discounts are available. Downtime is much less drastic than a C02 laser treatment. Significant peeling may or may not occur, it all depends on your skin. Some people experience severe peeling while other people experience mild dryness and/or redness. Tightness and a dry feeling is also common with treatment.
Medical grade peels like Obagi Blue work best, but must be performed in a Doctor’s office.