WHAT ARE ACNE SCARS?
Acne scars are permanent textural changes and indentations that occur on skin due to severe acne and scars cannot be erased.
How are Acne scars caused?
Acne scarring is often the result of delayed and/or inadequate medical treatment but can develop despite appropriate medical therapy. Collagen and other tissue damage, secondary to inflammation of acne, leads to permanent skin texture changes and fibrosis.
TYPES OF ACNE SCARS:
Atrophic scars – flat, thin scars or depressed scars
Hypertrophic or keloid scars – thick lumpy scars.
Ice-pick scars – these are deep, narrow, pitted scars
Rolling scars – broad depressions with a sloping edge
Boxcar scars – broad depressions with sharply defined edges
TREATMENT OF ACNE SCARS
Acne scars can be managed by
- Chemical Peeling
- Chemical Reconstruction of Skin Scars (CROSS)
- Dermal fillers
MINOR SURGICAL APPROACH
- Fat transfer
- Scar revisions surgerIes
- Punch techniques
- Skin Needling (Percutaneous Collagen Induction Therapy
- Laser Resurfacing
What are Chemical peels:
The most commonly used chemical peels in treating acne and acne scars include salicylic acid peel, glycolic peel, jessners solution and trichloroacetic acid.
Peels can improve skin texture, pigmentation, and tone. However, adequate control of the peeling depth may be difficult to achieve.
What Is CROSS Technique?
It uses chemical trichloroacetic acid over atrophied acne scars which leads to improvement in the depth of scars .Three to four sitting with three to four weeks interval is required to obtain optimum results.
How dermabrasion improves acne scars?
This procedure removes the layers of the skin which are superficial and which inturn leads to remodeling of skin, increased skin thickness, and enhanced hydration.
It is primarily used for well-defined superficial scars with distinct borders or broad-based scars with indistinct borders. However, it is ineffective in treatment of deep scars, and demonstrates fair to moderate efficacy in moderate scars.
WHAT IS SUBCISION:
It Is the fibrous tissue (tethers) that binds down the scar, In subcision the fibrous tissue is released resulting in scar elevation.The induced dermal trauma results in clot formation and neocollagenesis with subsequent filling of the created space, which further enhances scar elevation.
SKIN NEEDLING (DERMAROLLERS)
Percutaneous Collagen Induction Therapy. This modality creates microclefts in the dermis, and the subsequent dermal trauma initiates a wound healing process that induces a cascade of growth factors, resulting in collagen production
WHAT ARE DERMAL GRAFTS
Dermal grafting, the implantation of appropriately dissected deep dermis (graft) into recipient areas, is an old procedure that is used to treat atrophic scars. Dermal grafting can be used to treat any round/oval facial scar that is soft, prominent, and at least 4–5 mm.
HOW IS AUTOLOUS FAT USED IN ACNE SCARS?
It is indicated for deep atrophic scars. it is advisable to perform subcision first. The longevity of correction is doubtful. Fat transfer has significantly improved deep acne scars and texture.
FILLERS BE USE IN ACNE SCARS?
Fillers can be used alone or in combination with prior subcision to improve the appearance of atrophic acne scars. Fillers containing hyaluronic acid, calcium hydroxyapatite, and poly-L-lactic acid (PLLA) are increasingly used to correct atrophic acne scarring. Injection of cross-linked hyaluronic acid improves the quality of overlying skin
WHERE DO WE USE PUNCH TECHNIQUES IN ACNE SCARS?
Punch techniques such as punch excision, elevation, grafting, or float techniques are considered the criterion standard for punched-out scars up to 3–4 mm in width (deep boxcar and larger icepick scars). These scars do not improve substantially with resurfacing procedures. The use of fractional resurfacing laser after punch techniques helps to even out scars.
PUNCH ELEVATION: Punch elevation is a technique in which the scar is punched down without being discarded. The punched scar is then elevated and sutured in place at a level slightly higher than the surrounding skin
PUNCH EXCISION: The scar is excised down with the help of a punch instrument that is slightly larger than the scar, and the defect is closed with sutures along relaxed skin tension lines.
Punch excision and elevation is best suited for small (B 3 mm) acne scars.
HOW ARE Fractional Lasers HELPFUL FOR ACNE SCARS?
It leads to formation of zones due to injury which further leads to repair of the skin. It improves moderate to severe acne scarring and yields superior outcomes when compared with nonablative lasers.
WHAT ARE THE FACTORS ON WHICH OUTCOME OF THE TREATMENT DEPENDS?
Patients with moderate to severe acne scarring most often need multimodality therapies for optimal and faster results, and the cost of such is an important aspect to discuss from the beginning. Acne scar type and severity, dyspigmentation, textural issues and patient’s skin type need to be considered to optimize outcomes.