Acne scars that result from severe cystic or nodular lesions can be improved using skin resurfacing procedures, dermal fillers or a combination of both. Skin resurfacing techniques are most effective in treating a global scarring pattern that affects multiple areas of the facial skin. Dermal fillers soften both superficial and deep, ice-pick scars. Dermal fillers are best suited for patients with mild scarring that affects only specific areas of the facial skin.
The most important step in treating acne scars is to control any active acne. Skin resurfacing, dermal fillers, and skin bleaching medicines can all lead to outbreaks if the acne is not under control.
At our La Jolla (San Diego) plastic surgery office, Dr. Kolstad will tailor a specific treatment strategy to meet your unique concerns.
SKIN RESURFACING (ACNE SCARS)
There are a variety of skin resurfacing technologies available including chemical peels, CO2 lasers and dermabrasion. Each tool has unique properties which preferentially treat specific types of acne scarring: shallow, medium depth or ice-pick.
SHALLOW ACNE SCARS
Glycolic Acid, Salicylic Acid, Obaji, Trichloracetic acid, Blue and hundreds of other chemical peels are available. There are so many types of chemical peels that many people, including doctors, are confused about which peel should be used for which skin condition. A simple explanation is that any peel purchased over the counter, or performed by a nurse or aesthetician will only treat the outer layer of skin. This leads to a mild exfoliation but not significant improvement in acne scars. In San Diego there are dozens of medical spas promising to fix acne scars, but superficial chemical peels will rarely produce any meaningful results.
TCA peels (30-35%) should only be performed by trained providers, typically Facial Plastic Surgeons or Dermatologists. This medium depth peel treats shallow acne scars and skin pigmentation spots resulting from Post Inflammatory Hyperpigmentation (PIH). Chemical peels are performed in the office under local anesthesia and are my preferred treatment for shallow acne scars on patients in their 20s-30s.
MEDIUM DEPTH ACNE SCARS
CO2 lasers are a good treatment for medium depth acne scars. Most current lasers remove the outer layer of skin (epidermis) and a little of the second layer of skin (dermis). CO2 lasers also stimulate fibroblasts to produce collagen underneath and in the skin. The new collagen softens acne scars and tightens skin that has started to succumb to the effects of gravity. Laser treatments are performed in the office under local anesthesia and are my preferred treatment for medium-depth acne scars on patients in their 40s-50s. Lasers are expensive for doctors to buy, and consequently laser treatments will frequently be a more expensive then chemical peels.
DEEP, ICE-PICK ACNE SCARS
Deep, ice-pick acne scars both layers of skin (epidermis and dermis) as well as the layers underneath the skin. This is the hardest type of acne scarring to treat. I typically explain to patients that even with the best technology available, only about a 75%-85% improvement can be achieved. Deep acne scars are best treated with dermabrasion or phenol chemical peels. Dermabrasion is the process of using a diamond-coated wheel to sand away the outer layers of the skin. This is a very different technique then “microdermabrasion” performed by aestheticians. Dermabrasion allows the doctor to preferentially treat very deep scars while only lightly sanding the unaffected skin. Phenol peels are the most effective and deepest chemical peels available. Both dermabrasion and phenol peels require a very highly trained provider to minimize the risk of complications. They typically require sedation in addition to local anesthesia and are performed in a surgical setting.
If you have questions about treatment for acne scarring please contact Kolstad Facial Plastic Surgery to schedule a consultation with Dr. Kolstad. You may call our office at 858.859.2563 to schedule your appointment today. We are conveniently located in in La Jolla between I5 and I 805. We serve men and women in La Jolla, Del Mar, San Diego, Rancho Santa Fe, Solano Beach, Encinitas and Southern California.
