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The problem of acne scarring stands out as one of the most prevalent cosmetic concerns,
often leading to psychological distress. Post-acne scarring affects a significant majority,
with up to 95% of patients grappling with acne vulgaris experiencing these lasting effects.
The repercussions extend beyond the physical, triggering emotions such as embarrassment,
low self-esteem, and, in severe cases, depression. The impact on an individua's emotional well-being is profound, contributing to feelings of social isolation and significantly
compromising their overall quality of life.
How Do Acne Scars Develop?
Acne scars develop as a result of the skin's natural healing process after severe or
inflammatory acne lesions. Acne scarring can range in appearance from indents, raised
areas and pigmentation. Here' a breakdown of how acne scars typically form:
1. Inflammation and Lesion Formation
When you have inflammatory or severe acne, the skin pores become clogged with excess
oil, dead skin cells, and bacteria. This can lead to the formation of papules, pustules, or
nodules.
2. Tissue Damage
In severe cases, the acne lesion can penetrate deep into the skin, causing damage to the
surrounding tissue. The bod's natural response to this damage is to initiate the healing
process.
3. Collagen Production
As the skin heals, the body produces collagen, a fibrous protein responsible for maintaining
skin structure. The amount and organization of collagen produced during the healing
process can vary from person to person.
4. Formation of Scars
If there is an excess or insufficient production of collagen during the healing process, it can
result in the formation of scars. Too much collagen can lead to raised scars above the skin
(hypertrophic or keloid), while too little collagen can result in depressed scars (atrophic).
The extent of scarring is intricately tied to two key factors: the depth within the dermal
pilosebaceous unit where inflammation and wound healing take place, and the duration of
the inflammatory process. Additionally, an individual's genetic predisposition to scarring plays a crucial role in determining the severity of acne scars. By far the most common type of acne scar is atrophic scar types.
Types of Acne Atrophic Scars
Icepick scars (60-70%)
- Narrow, v-shaped, deep pits resembling small puncture wounds that have sharp margin that extends vertically to the deep dermis or subcutaneous tissue.
- Less than 2mm in diameter
Boxscars (20-30%)
- Wider, round-to-oval depressions with sharply demarcated vertical edges.
- 1.5 – 4.0mm in diameter
Rolling scars (15-25%)
- Widest scars with sloping edges which create a wave-like appearance and result in superficial shadowing.
- More than 4.0mm in diameter
Treatment Approach
The management of acne scarring poses a unique challenge due to the often heterogeneous nature of scars seen in patients. A comprehensive treatment approach becomes imperative, considering that many patients present with a combination of different types of atrophic acne scarring, including icepick scars, boxcars and rolling scars. In such cases, a singular treatment modality may prove insufficient to address the diverse range of scars effectively.
Therefore, a combination of treatment modalities is increasingly recognized as a judicious
strategy.
To comprehensively address atrophic acne scarring, a multifaceted strategy may include the
use of chemical peels, specifically salicylic acid peels. These peels are highly effective in
promoting skin exfoliation and addressing superficial hyperpigmented scars. Furthermore,
the application of the trichloroacetic acid (TCA) CROSS technique, known as Chemical
Reconstruction of Skin Scars, is a targeted approach for deep-set icepick scars. This
technique involves the precise application of TCA to the scar, leading to the destruction of
the epithelial tract. Subsequently, during the healing phase, collagenization occurs,
contributing to the filling of the depressed icepick scars.
Moreover, integrating platelet-rich fibrin (PRF) with microneedling augments the overall
rejuvenation process, fostering collagen synthesis and enhancing skin texture. Another
valuable technique is subcision, involving the use of a needle or cannula to disrupt and
detach the fibrous strands that tether scars. This process facilitates the replacement of
these strands with normal connective tissue during the healing phase. By releasing the
fibrous tissue, subcision effectively elevates the scar, thereby contributing to a reduction in
its appearance. This technique is particularly beneficial for addressing rolling acne scars.
Combine Subcision with Injections
The subcision technique, when combined with polynucleotide injection, presents a distinct
advantage by promoting skin healing and regeneration. This combination expedites the
skin's intrinsic healing mechanisms, facilitating the repair of damaged tissues. Additionally,
the strategic use of injectable fillers, such as hyaluronic acid fillers, proves effective in
augmenting soft tissue. This is particularly beneficial for addressing soft rolling or boxcar
scars, where these fillers help restore volume to depressed areas, thereby minimizing the
visible impact of atrophic scars. Notably, synthetic fillers like calcium hydroxylapatite
(CaHA), available as Radiesse®, have demonstrated improvements in boxcar scars,
especially when used in conjunction with the subcision technique.
Furthermore, the incorporation of fractional ablative lasers, exemplified by the Fotona SP Dynamis NX Line laser, holds a pivotal role in skin resurfacing. This laser technology plays a dual role by stimulating collagen production and enhancing the overall texture of the treated area. Laser resurfacing for acne scarring harnesses monochromatic light to deliver controlled thermal energy. This targeted approach stimulates dermal fibroblasts, prompting the replacement of lost collagen and elastin fibers. The result is a rejuvenated and smoother skin surface, making fractional ablative lasers an integral component of a comprehensive treatment plan for managing atrophic acne scarring.
Nutshell
An array of effective treatments for atrophic acne scars has been developed. By integrating
these diverse modalities into a comprehensive treatment plan, we ensure a synergistic
approach to address the multifaceted challenges presented by atrophic acne scarring,
providing you with a tailored solution for optimal outcomes. Welcome to Dream Clinic, where you can schedule a consultation with us to explore the personalized options available for your unique skincare needs!
