What are the acne scars?
Acne affects 70-80% of young adolescents and as a result can leave significant scarring both on the face and on the body (torso and shoulders), which can have a considerable impact on the person’s affective, social and working lives. Acne also affects adult women of a child-bearing age (tardy acne).
Active acne lesions give rise to scarring with different forms and depths and often a combination of different types of scars can be noted, sometimes even merging into one another. Obviously, the best therapy is prevention with an appropriate and rapid therapy for active acne. However, once the scars have formed, they have to be treated with methods that are integrated into the context of a global strategy that can include the use of this or that method, or a combination, in consideration of the single case in question. All the corrective mini-surgical techniques are carried out as an outpatient, following a local anaesthetic, but the duration of any corrective therapy of the scarring may require lengths of time, even many months, even though the single operation has mini invasive characteristics and allows a rapid return to one’s social and working life.
Treatment of acne scars
Amongst the various minimally invasive surgical techniques we should recall the use of subcision, a method which comprises the use of special needles (Nokor needles) which permit the detachment in depth of the scar adhesions and the lifting of the scar. Subsequently, it is possible to maintain the lifting with the implant of injectable bio materials (hyaluronic acid), or better still, adipose tissue, taken from the patient himself (lipofilling), which, being rich in stem cells, is able to induce regenerative effects on the scar tissues.
Some scars can be removed surgically with special cylindrical scalpels (punches) and substituted with a small linear scar, which is almost invisible and in any case can be improved later. In some cases the scar which is removed can be substituted with a micro graft of the patient’s own skin, taken from a hidden area. In this way, a certain uniformity is restored to the surface of the skin, which can be further improved by laser treatments.
Treatment of acne scars with laser
The laser which has shown the best capability to remodel acned tissue is the Er: Yag fractional laser 1540, which can penetrate up to 1 mm into the context of the dermis and produce a photocoagulation of the tissues, with a combined thermal stimulation and resulting regeneration of the tissues which are architecturally better structured. From 3-8 laser sessions are normally needed to achieve optimal remodeling. Another laser which we often use in these patients is the CO2 fractional laser, which can produce a non mechanical dermabrasion of the surface, combined with a significant thermal stimulation. All laser treatments can be carried out on some areas only, but generally we prefer to treat the whole area affected be the problem. The combination of these two lasers and their innovative technology allows us to obtain extraordinary results, which, up to a few years ago, were not possible.
Even radio frequency (Thermage) can produce significant remodeling of the dermis and can be used in combination with the other methods described for an overall improvement in the condition of the skin.
All of the methods described can even be used singularly, but their integration and combination can certainly offer better results. It is evident that the protocol and the action strategy can only be formulated after a careful direct appraisal of the case and with a wide sharing of objectives with the patient.