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The road to acne scar revision

Cystic acne is the main culprit of acne scars, because it creates a bag of pus within the skin. When the pus resolves, the hollow space it leaves behind forms a crater on the skin. When one has cystic acne flares, acne scarring ensues.

There are numerous modalities that can improve acne scars and large pore size. As dermatologists, we follow guidelines as to what modality to use to treat a certain type of scar. But we must also remember that the results of same treatment may vary from person to person. 🧐

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The earlier, the better

Newer hypertrophic scars are easier to treat!

She developed a hypertrophic acne scar on her nose 1 week before she came to the clinic. I did a combination of steroid injection to flatten the scar and IPL to reduce the redness. After 2 treatments, I think we’ve made a lot of progress 😇

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For the new and few pimples

For mild acne vulgaris, fractional radiofrequency with or without needling is a good option. The heat contracts the sebaceous glands underneath the skin which prevents pimple formation. 🥰 Plus, if you have recent post-inflammatory erythema and very shallow acne scarring, this treatment may help improve the condition. 🤔 If you have older and deeper acne scarring, fractional RF needling is a better option for you. As this will also address the textural issues of your skin. 👌🏼

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Battle of the needles: microneedling vs. fractional RF needling

subcision + microneedling + fractional RF needling + LED light

Microneedling has been around for ages. It started with the dermaroller and evolved into the automated derma pen. The principle of these devices was to create minute channels on the skin for product infusion and collagen induction.

Recently, the fractional radio frequency needling phenomenon has been making waves in the industry. Its basic principle is quite similar to the manual microneedling device, but with a bonus! The tip of the insulated needles radiate heat which stimulates collagen production even further!!!

I have been using my automated derma pen for years! I combine it with different serums, my favourites are vitamin C and PRP, to boost the effect. I use a variety of depths depending on the facial area and the indication. It is quite a bloody procedure, hence the popular treatment name “vampire facial.”

While I love the how microneedling improves acne scars, I must say that fractional RF needling is microneedling on steroids!!! One fractional RF needling treatment is “like doing three manual microneedling sessions,” according to my patient. Also, the procedure is less bloody than using the manual microneedling device. I can infuse peptides or PRP and add LED light therapy during one treatment session.

The only downside that I find with the fractional RF needling is that patients have a risk of developing scabs and hyperpigmentation post-treatment. NOT ALL patients develop this, but it is a risk especially for darker skinned individuals.

fractional RF needling
fractional RF needling

Scabs develop within 3 to 5 days after the treatment, and fall off within 7 to 10 days.

 

fractional RF needling
fractional RF needling

Here, you can see that there are hyperpigmented grid marks 3 weeks post treatment. Individuals with darker skin color, those who develop long standing dark marks after acne and those who are exposed to a lot of heat and sun light are more prone to develop post-inflammatory hyperpigmentation (PIH). Do not worry though, because PIH will resolve with the help of lightening agents and sun protection.

As you can see from the first 2 photos, adding fractional RF needling to the acne scar revision plan, improves acne scars faster than just using conventional manual microneedling device.

In my practice, I do a combination of treatments to improve acne scars. If you do see me, do not be surprised as I almost always begin treatment with subcision and/or PRP filler/buffer. I find that when you first treat the acne scars under the skin; there will be better result when you eventually do chemical peel, energy-based devices and/or lasers.

Acne scar revision is not a one-time treatment. Your board-certified dermatologist will make a custom treatment plan for you… and this plan will involve a variety of treatments, several sittings and a lot of patience. You’ll get there 🙂