IMPROVE ACNE SCARRING
Acne scarring is can be a concern for patients who during puberty have suffered from deep cystic acne. These scars tend to be located on the face, but on several occasions may appear on other parts of the body, particularly on the back.
A necessary prerequisite for a patient to begin the procedure is for the acne not to be in its active stage, or to have had a significant reduction and for the scarring to have been stabilized. In addition, one must be aware that completely erasing the scarring is unachievable. The extent of improvement will depend on the procedure applied and the type of existing scarring.
There are several methods of correction that a plastic surgeon may employ, such as peeling, surgical removal, or the use of injectable materials.
PEELING TO IMPROVE ACNE SCARRING
The most basic method of improving acne scarring is peeling. As has been explained in the relevant chapters these are divided into three variations, depending on the way in which they are performed; variation also exists depending on the depth of the operation on the skin.
Peelings, depending on how they are performed, can be labelled as:
• CHEMICAL PEELING: The skin is smoothed via a chemical agent. Acids are usually employed to clear the skin and allow new skin of better texture to grow. The scar tissue becomes smoother and the scars themselves become less deep, and therefore less visible.
• MECHANICAL PEELING: These are performed via the method of dermabrasion with a diamond wheel when a deep peeling is required, or using crystals for lighter peelings.
• LASER PEELING: There are two types of lasers that may be used on acne: carbon dioxide lasers (CO2 LASER) and Erbium Laser. Both aim to smoothen the scars and reduce their depth.
As far as depth is concerned, as mentioned before, the deeper the plastic surgeon digs into the skin, the better the results he can achieve. Of course, even deeper peelings cannot achieve a complete erasure of the scars, but can allow for a percentage of improvement in the 40%-70% margin.
Fractional Lasers – Radiofrequency
Their mechanism of action is based on the idea of distributing thermal energy in pixels, deep in the skin. The healthy skin left between the pixels, is able to provoke a fast healing process, which reduces the down time. In this way we have the benefits of the deep peeling (skin tightening and improved skin texture), without the disadvantages (long healing period). Fractional technology gives considerable improvement to the acne scars if repeated sessions are applied. The quality of the results depends on the type and quality of the laser or radiofrequency used, the intensity of the energy delivered and of course the experience of the Plastic Surgeon who performs it.
The length of the recovery period is dependent on the type of peeling method used and the depth of penetration. Deeper peelings tend to require a recovery period between 10 and 15 days.
Peelings are only performed during the winter months, and require the patient to be particularly cautious about exposure to the sun for a few months after their completion.
This method may be combined with others to further improve the result.
OTHER METHODS OF IMPROVING ACNE SCARRING
Apart from peelings, the following methods of correcting acne scarring are also available:
• SURGICAL REMOVAL:
This is typically employed only on very deep and large scars. The method consists in surgically excising the scar and suturing it. After the healing, a scar will be left, which in any way will be of much better quality than the preexisting scar. It is not a first choice method, but is often used to complement other methods when dealing with very intense scars.
• FILLING MATERIALS:
This is most often employed to deal with very particular types of scar and is not suited to general use. The plastic surgeon will inject a certain filling material, usually hyaluronic acid, to fill the scar and make it appear smoother. In any case, the essential aesthetic issue of scars and acne is not the scar tissue itself but the lack of evenness on the surface of the skin. This unevenness creates shadows especially when the light is lateral to the scar, thus making it more evident. Once the scar has been brought to a level with the rest of the skin following the use of filling materials, the general image is vastly improved. The disadvantage of this method is that it does not provide a permanent solution. The duration of the result, however, is quite lengthy (1-3 years). Of course, the most important advantage is that it is a very easy procedure that may only take approximately five minutes.
The presence of acne scarring can be particularly detrimental to the psychology of patients, especially the younger ones. Improving the problem tends to aid the psychological status of the patient, particularly at an age where she/he is fairly sensitive.