LASERS FOR ACNE SCAR
Acne vulgaris [''pimples''] is a common skin condition, known to occur in 80% of people in the age group of 11 to 30 years. Acne is a chronic condition with serious, long term facial imperfection. Post acne scarring can occur in 30 to 95% of patients with acne vulgaris. There is high incidence of scarring in patients with longer duration of the disease, hence the need for early treatment.
Acne scarring causes greater levels of stress, anxiety, depression, low self-esteem, and insecurity in patients. Some patients may have adjustment problems. The occurrence of scarring is hard to predict. The best method of preventing scarring is to treat acne early. Scarring is permanent, hence the importance of adherence to treatment to minimize the potential for scarring. Acne Scars are classified into:
- Atrophic and Hypertrophic: These scars are further categorized into:
- Ice pick scars
- Rolling scars and
- Boxcar scars
Atrophic scars are more common than hypertrophic scars. Scars occur commonly on the face.
Hypertrophic scars / keloidal scars are common on the upper chest and back, sternum, collar bones, as well as shoulders and sometimes on the angles of the jaw.
The main goal of all acne scar procedures is to achieve maximal improvement rather than perfection in most of the cases. A multimodality approach is required for the treatment of acne scars, including back acne scar treatment.
WHAT ARE THE TREATMENT OPTIONS AVAILABLE FOR POST ACNE SCARS?
Acne scars laser treatment is perhaps one of the most commonly used nonsurgical modality for the treatment of post acne scars, especially facial acne scars. Different laser systems are available for post acne scars, but fractional lasers and radiofrequency devices are the most favoured as of now.
WHAT ARE THE INDICATIONS FOR LASER TREATMENT IN ACNE SCARS?
Acne scars laser treatment can be considered:
WHAT ARE THE TYPES OF LASERS & NON ABLATIVE SKIN RESURFACING TECHNOLOGIES USED FOR ACNE SCARS?
- In any patient in whom the scars are causing significant psychological trauma
- Patients with grade 2 and grade 3 acne scars
- Patients with grade 4 acne scars have to be treated with multiple treatment options such as laser resurfacing, subcision, fillers etc., as a single treatment modality may not give satisfactory results in these patients
The most common acne scar procedures also include:
Advantages of Non-Ablative Lasers:
- Non-Ablative Lasers:
- IPL, Pulsed dye lasers and broad band light sources
- Q-switched ND-yag, Erbium glass laser etc.
Laser remodelling by non-ablative lasers is based on controlled injury to the dermal collagen without any damage to the epidermis. This controlled injury leads to a healing response with dermal collagen re-modelling. This causes a tightening effect on the skin with improvement in the appearance of the scars. There is no significant downtime; however, multiple sessions are required. This is considered as one of the best acne scar removal treatments by some.
- Ablative Lasers: These include CO2 laser and erbium - YAG laser
Ablative lasers are perhaps the best treatment for acne scars as well as the most effective in the treatment of post acne scars.
Higher incidence of adverse effects and prolonged downtime
- Fractional Lasers: The main advantage with fractional lasers is shorter downtime and minimal side effects.
Advantages of Radiofrequency:
- Radiofrequency Devices [RF]: These devices cause thermal injury which alters the shape of the collagen fibrils. Heated fibroblasts lead to new collagen formation and subsequent tissue re-modelling, which is cosmetically beneficial. Radiofrequency can also be used for reversing the changes of photo-aging.
These technologies provide safe and effective results with little or no downtime. Non ablative lasers and light systems induce dermal neo-collagenases without disrupting the epidermis, thereby reducing the recovery time, and limiting the side effects. Some dermatologists consider using RF devices as the best treatment for acne scars
WHAT ARE THE OTHER TREATMENT MODALITIES AVAILABLE FOR ACNE SCARS APART FROM LASERS?
As we have already discussed, acne scarring requires a combination approach. Each type of scar requires a different treatment. Apart from acne scars laser treatment, various other techniques can be used to raise or replace or resurface acne scars. Some of these techniques include:
WHAT IS THE POST PROCEDURE CARE TO BE TAKEN AFTER LASER TREATMENT FOR POST ACNE SCARRING?
- Microneedling [also known as derma roller therapy or collagen induction therapy or skin needling therapy]
- Punch flotation or punch excision
- TCA cross technique
- Chemical peeling
- Fillers etc.
As prescribed by the dermatologist after an acne scar treatment, an anti-inflammatory/antibiotic cream may be applied for 3 to 5 days. Sunscreens should be applied. Sun exposure must be avoided. Harsh chemicals must be avoided.
Any cosmetic treatment must be avoided for at least 2 weeks after the procedure.