Question: My daughter is 24. She’s had horrible acne for years that has finally cleared up, but it’s left her with some pretty severe acne scars. Will this improve at all on its own as she gets older or is there some sort of treatment that could help? I know she is very self-conscious about her skin.
Answer: The actual acne scarring does not typically get better over time but frequently the appearance of the acne scarring can improve since oftentimes patients are left with some redness in the acne scarred area, which makes this appear worse since the redness almost looks like a shadow. Allowing the redness to subside or treating the redness with various lights and lasers to make it disappear can impact the overall appearance of the acne scarring in a very significant way. If there is no color difference in the acne scarring itself, then consideration of some fractionated laser treatments would be appropriate since we can typically make an extremely significant impact on the visual quality of the acne scarring so that it is much less noticeable. Unfortunately, we are never able to completely get rid of acne scarring no matter what treatment modality is employed.
Question: I have sporadic acne scarring on my face. Is it possible to spot-treat these areas with a chemical peel instead of treating my entire face?
Answer: It is certainly possible to spot treat acne scarring though I would personally recommend ProFractional Laser resurfacing over chemical peels since you would need a very deep chemical peel to make a significant improvement in acne scarring and this would leave the skin with a different texture and color than the surrounding area. We can avoid this color change by treating with a fractionated Erbium laser in a series of three treatments spaced about a month apart. I have seen dramatic improvements in acne and chickenpox scars or even traumatic or surgical scarring using this protocol.
Question: What combination of techniques are the most effective for removing acne scarring? Does it matter if the scarring is older? I’m 54-years-old and my acne scars are from my teens.
Answer: My personal recommendation for acne scarring today is a series of ProFractional Laser treatments that create tunnels of injury into the skin and this creates new collagen in the deeper dermis which in turn remodels the scarring and creates a smoother external appearance. While acne scarring cannot be cured, and we can certainly never rid somebody of the appearance of acne scarring, we can definitely make things look quite a bit better with these advanced laser techniques.
Question: Should laser skin resurfacing be considered to treat severe acne in a teenager?
Answer: Laser skin resurfacing can certainly be considered to treat severe acne in a teenager as long as the acne has been adequately controlled and is no longer active. I would also want to wait until that teenager is finished growing and has gone through puberty before consideration of this. Other things to consider would be whether or not the teenager has been placed on Accutane in the recent past as I would want to wait about a year after the Accutane has been discontinued before we would want to do any sort of laser resurfacing on that patient. If all of these criteria are met then we can certainly consider a laser resurfacing and I would typically, at this point in time, recommend a ProFractional Laser, which is fractionated Erbium resurfacing where only a small percentage of the actual skin is injured, but it is injured in tunnels that go down deep into the skin and lay down extra heat to create a large amount of new collagen deposition which in turn can really significantly improve the appearance of acne scarring. At this time, I recommend three separate treatments spaced at least a month apart, but we can provide very significant improvements in acne scarring with this regimen.
Question: What are some techniques used for improving acne scarring?
Answer: There are multiple different techniques that can be employed to try to improve the appearance of acne scarring from as simple as filling the area with an injectable filler to subcision with a needle in conjunction with some filler material to fat grafting or more aggressive treatments, such as laser resurfacing. My personal gold standard at this time is actually a ProFractional Laser by Sciton, which is a fractionated Erbium laser where tunnels are vaporized into the skin and this creates a large amount of new collagen deposition into the dermis which in turn remodels the overlying epidermis and can create a very significant improvement in the appearance of acne scarring. The downside is that I recommend three treatments spaced at least a month apart, so the overall downtime can be very significant since each treatment requires about four or five days where the skin is healing. A very conservative approach, such as microdermabrasion or superficial or even medium-depth chemical peels, does very little for acne scarring and I recommend that patients avoid these techniques due to the fact that they are really not going to get any visible improvement in their acne scarring unless a more aggressive approach is undertaken.
Question: Can laser skin resurfacing get rid of acne scars?
Answer: The short answer to your question is that nothing can get rid of acne scars since once scars are in the skin there really is no way to make a scar completely disappear. The goal is to try to make a scar less visible and, from that respect, we can certainly do various different laser treatments to the skin to make acne scarring much less noticeable.
Question: My daughter is 20 and had problems with acne that have finally subsided leaving her with scars. Can fat injections help to smooth out the scars from adolescent acne problems?
Answer: Fat injections can definitely improve upon acne scarring but is certainly not going to be 100% effective and requires experienced hands to not only place fat into this area but also to lyse or cut the scar tissue beneath the acne scarring in a very precise and consistent manner. Depending on your daughter’s actual appearance of the acne scarring, I may or may not recommend laser treatments for a better result in my hands.
Question: My skin is incredibly oily and I have intermittent bouts of acne. Do you think microdermabrasion would solve this problem?
Answer: Microdermabrasion certainly will not solve oily skin problems, but microdermabrasion does help with acne by getting rid of the dead layer of skin on the surface which can clog pores and promote acne. Microdermabrasion further improves the efficacy of good skin care and this will also in turn improve you overall skin health and should reduce your acne significantly.
Question: I have severe acne on my face and especially my cheeks. I really want to have cheek implants but I am worried that this procedure will be a hindrance to improving my skin condition. Is this something I should be worried about?
Answer: No, you really should not worry about cheek implants creating any issues with your skin since the implants are literally placed down directly against the facial bones and really will in no way affect your overlying skin. You certainly can still undergo treatment for your acne scarring and I personally like the ProFractional laser by Sciton as my gold standard for treatment of acne scarring of the face.
Question: I have very bad facial acne scars. I hate looking like this and it seems to look even worse every year. I am Mexican and have darker skin, is there a laser peel that I can have that will not change my skin color but will get rid of some of the pitting on my face?
Answer: That is a very good question and a very difficult problem to correct. First of all, bad acne scarring is virtually impossible to completely get rid of but we can certainly perform different procedures to improve upon the appearance of acne scarring and with your darker skin type this greatly limits the type of techniques that are available for treatment of this. I would recommend consideration of a ProFractional laser treatment by Sciton as this laser only injures a small percentage of the actual skin by lasering small tunnels in the skin. These injuries cause the skin to deposit large amounts of collagen in the deeper layer and this causes remodeling of the surface of the skin which can greatly reduce the appearance of acne scarring. I would recommend a small test spot before treating the entire area to assure that it does not affect your overall skin coloration. But more than likely it will be safe to use in your skin type.