Scar formation is from a disorder of collagen and fibrinogen formation along the lines of injured sub dermal tissues; or otherwise stated, deregulation of the repair pattern in the dermis due to your immune systems response. Sun damage, medications, hormones, stress, and diseases of the skin cause these problems. As such, each person’s response is different and their treatment is tailored to deal with them.
It is this individualized approach, treating a person’s problems at every level, that has shown continued repair and improvement. If your hormone level is off or stress from family/job or ongoing infections are unresolved, we won’t try to fix a scar problem until you can optimally respond. Many different tools, techniques and medications are at our disposal to treat these needs.
CHEMICAL PEELS — Chemical peels involve the application of chemical substances to ablate definite skin layers; the subsequent cutaneous regeneration tightens the skin and evens the color. The decision to use chemical peels in the treatment of photo aging depends upon individual patient values and preferences.
LASER ABLATION: Technology for ablative laser resurfacing has continuously evolved. The procedure was first performed in the 1980s with the continuous wave carbon dioxide (CO2) laser. Use of this laser was complicated by an unfavorably high risk of adverse effects, and the subsequent development of pulsed CO2 lasers and rapidly scanning continuous wave CO2 lasers improved the safety of treatment . In the 1990s, the erbium: yttrium aluminum garnet (Er:YAG) laser was introduced as an alternative device for ablative laser resurfacing. Advantages of Er:YAG lasers included more precise control over the depth of cutaneous ablation and a lower incidence of adverse effects.
Through the ablation of the epidermis and portions of the superficial dermis, as well as the induction of collagen remodeling in the deeper dermis, ablative laser resurfacing can reduce rhytides (wrinkles), dyschromia, vascular changes, and skin laxity.
Fractional lasers can deliver a multitude of narrow columns of laser light to the skin, resulting in the creation of numerous microscopic vertical zones of thermal damage called microscopic thermal zones (MTZs) (figure 1). MTZs are usually less than 400 micrometers in diameter and up to 1300 micrometers deep; the type of fractional laser and specific laser settings determine the size of the MTZ .
The undamaged surrounding skin immediately adjacent to an MTZ serves as a reservoir of viable tissue, permitting the rapid repopulation of the epidermis observed after fractional laser therapy . Reepithelialization typically occurs within a few days. In contrast, reepithelialization after traditional laser ablation is dependent on migration of epidermal cells from adnexal structures . A skin tightening effect also occurs after treatment with ablative fractional lasers; both immediate and delayed collagen contraction and collagen remodeling may contribute to improvements in skin laxity [7,62]. This is the standard of care for acne scar treatment.
SKIN NEEDLING — Skin needling procedures can improve acne scars. Similar to fractional lasers, needling procedures induce small columns of damage in the epidermis and dermis, leaving intervening skin untouched. A needling device typically consists of a cylinder that is circumferentially studded with 1 to 2.5 mm long needles. The device is rolled over the surface of the skin to form numerous perforations in the epidermis and dermis with a goal of stimulating neo-collagenase.. Advantages of skin needling include low cost, a relatively short recovery period (two to three days) and a very low risk for post inflammatory hyperpigmentation . The depth of treatment is limited.
INDIVIDUAL ATROPHIC ACNE SCARS — Patients with isolated acne scars or who are only concerned about specific scars may not require extensive collagen remodeling procedures to achieve the desired level of improvement. Procedures such as subcision, punch excision, punch elevation, chemical reconstruction of acne scars (CROSS technique), injection of soft tissue fillers, and focal ablaition can effectively treat individual lesions.
Focal treatments that are most appropriate based upon scar type are:
- Ice pick scars – punch excision or CROSS technique
- Boxcar scars – CROSS for small scars, punch or elliptical excision, punch elevation, or focal ablaition
- Rolling scars – subcision or injectable soft tissue fillers
With the wide variety of tools available, there is a treatment available for your skin type and problem area. Schedule your consultation today!