In revising old acne scars, a proper evaluation must be made to ascertain the type of scars the patient has. Aside from this, one should also take into consideration the patient’s skin type and lifestyle.
Remember that each patient and unique… and so is their treatment. There are many combinations of procedures that can be done but everything should always be customized to the patient’s needs and lifestyle.
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. 🧐
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.
Scabs develop within 3 to 5 days after the treatment, and fall off within 7 to 10 days.
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 🙂
TCA CROSS or chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA) is technique that allows focal treatment of acne scars. Ice pick scars and boxcars are ideal lesions for this procedure. A very high concentration of TCA solution is applied precisely on the scars using a sharp wooden toothpick or a syringe to induce inflammation and collagen production of these deep acne scars. A white frost will develop on the affected areas within 10 to 15 seconds, and burning sensation will be felt by the patient. After a 3 to 5 days, scabs will form. These crusts will fall off in 7 to 10 days revealing a shallower scar. Several treatment sessions may be required depending on the severity of the condition.
In my practice, I combine TCA CROSS with other procedures to hasten improvement. But, compared to other procedures, I only do TCA CROSS every 6 to 8 weeks. I prefer to give the skin time to adequately heal. I find that if I do TCA CROSS within a short interval, the skin will improve depth-wise, but will develop hyperpigmentation. :-O