Patients often wonder whether acne scars can be removed or at least corrected. Currently, there are several laser techniques that allow them to be concealed as much as possible. Dr. Adriana Ribé, specialist in Pathological Anatomy and Dermatopathology, trained at Hospital Clínic and New York Presbyterian Hospital, with extensive experience in cosmetic dermatology and laser techniques, explains what type of laser is recommended in each case and what the treatment will consist of.
Patients often ask if an acne scar can be erased. It is not possible to remove it while leaving the skin completely intact, since there has been a break in the integrity of the skin after the inflammatory process. But acne scar treatments can fade acne scars until they are very inconspicuous. Patient satisfaction with these treatments is very high.
After acne we may have red marks or scars. Red marks are a residual consequence of the inflammatory process. These can remain for weeks or months so that, although the pimple has disappeared, the red mark (or brown in some cases), remains. These post-acne marks can be attenuated with fractionated laser or radiofrequency and sometimes with the application of specific creams.
These post-acne scars appear when the sebaceous gland becomes considerably inflamed, the surrounding collagen fibers are destroyed and replaced by scar tissue with lower quality collagen. Thus, the dermis atrophies and the epidermis becomes depressed. There are three types of post-acne scars:
- “boxcar scars” or “boxcar” scars because of their shape, with a wide diameter (more than 2 mm) and sharp edges.
- Ice pick scars: these are punctiform (diameter less than 2 mm) and deep.
- Rolling scars: these are softer depressions that affect large areas and give an irregular and etched skin appearance.
The treatment of these scars is different for each of them, although many patients present scars of all 3 types and, therefore, treatments should be combined.
How treatment for post-acne scars works
Laser and radiofrequency activate the formation of new collagen in the dermis and remodel the old one so that the scar “fills in”. They also regenerate the atrophic epidermis.
Thus, progressively, the scars of the skin are softened. The scar can be reduced by 80%. Scar treatment results depend on the type of treatment, the number of sessions performed and the type of scar, as some scars respond better than others.
How do I know if the treatment is right for my type of acne scar?
First of all, a visit will be made to evaluate the type and degree of scarring and propose the most appropriate therapy, which can be monotherapy or a combination of techniques. As there are various degrees of acne scars, one type of laser or another will be used to attenuate them:
- In mild to moderate acne scars the best option is the Fraxel re-store laser with a session every 15-30 days, counting a total of 3-5 sessions. In addition, the heat of the laser helps to destroy the Propionebacterium Acnes bacteria in case there is still residual active acne.
- In deep acne scars, we recommend fractional CO2 laser in 2 sessions, one every 3-6 months. It is a more aggressive laser. Before its application anesthetic cream is required. Fractionated picosecond laser (Resolve) can also be applied in 4-6 sessions, one every 1-2 weeks.
- E-matrix fractionated subablative radiofrequency is used for both grades of scars. We recommend 3-5 sessions, one every 3-4 weeks.
What will the skin look like after acne scar treatment?
After laser treatments for acne scars, the skin may react slightly:
- With Fraxel laser re-store (mild to moderate scars), the skin may be red, hot and slightly swollen after the session. Social life can be resumed immediately.
- With the fractional CO2 laser (deep scars), the skin will be red and hot after the session, with tiny crusts of less than a millimeter that disappear after a week, so it is recommended to stay quietly at home during that period.
- With the fractionated picosecond laser the skin may be red, hot and a little swollen after the session. Social life can be resumed immediately.
- With E-matrix fractionated radiofrequency the skin may be red, hot and slightly swollen after the session. As in the previous case, social life can be resumed immediately.
Are there any risks involved in the treatment of acne scars?
Both the risk and side effects are very unlikely and, in any case, not very important. The important thing is to protect yourself from the sun with a high protection factor (SPF +50). These treatments for scars can be done all year round following the instructions of the doctor specialized in Aesthetic Medicine and Dermatopathology.
Care to be followed after the treatment of acne scars
Simply apply a healing or moisturizing cream on the treated area for a few days, as well as sun protection (SPF +50). In the case of deep scar treatment, an antibiotic cream and herpes simplex prevention is recommended, as well as sun protection (SPF +50).