Overview
Over recent years, research and development into the treatments of acne & acne scarring has enabled more effective results in what has been up until now a difficult problem to improve. Unfortunately in the past, acne has usually been an accepted part of adolescent years, however many patients speak of the embarrassment and sometimes interpersonal problems that have occurred to them during that period of time. For some, failure of adequate treatment, or lack of treatment can result in a lifetime of frustration and self-consciousness with post acne scarring.
Acne
Acne, if treated early can usually be just an annoyance for a short period. Unfortunately, misinformation about the causes of acne, ranging from poor diet to inadequate cleansing of the skin can cause confusion. If inadequate treatment of the cause is not provided quickly then acne scarring is inevitable. Acne can be exacerbated by a number of factors, however the primary cause is a combination of genetics and hormonal factors leading to increased oil production by the sebaceous glands in the skin. Effective treatments range from oral antibiotics, glycolic acids, vitamin A derivatives, topical applications, hormones and lasers.
Acne Scars
Acne scarring is usually distinctive in either its colour or tissue structure. Typically, a scar may appear redder and thicker at first and then gradually fade. Many healing scars that seem unsightly at three months may improve if given more time. Scars that are a result of lack of tissue are usually more common and may appear as indentations – ‘ice pick’ or depressed scars. Other colour variations in acne-scarred skin such as ‘hyperpigmentation’ (increase in colour) are more common in olive or Asian skin types and usually fade over time, usually from three months to one and a half years. Red scars will usually mature over time and lose their distinctive colouring. It is important to protect scars from the sun as it is with any part of the skin to reduce colour changes.
Treatment Options
The past three years have seen many new options in the treatment of acne scars and skin rejuvenation in general. Acne scar treatments can range from non-invasive, with little or no ‘down time’, to more invasive treatments depending on the individual patient’s situation or the result they would like to achieve.
An innovative new technology is the Affirm laser with its ‘combined fractionated wavelengths’ that helps both firm and smooth the skin by significantly increasing the production of new collagen growth, in our opinion better than any other previously available fractional lasers.
Dr Rich has found that a combination of treatments for acne scarring is usually more beneficial than any one type of treatment. Sometimes several treatments may be required to obtain optimum results.
Acne and Acne Scar Treatments
- Affirm – Australian first – new ‘dual wavelength fractionated’ laser, two treatments in one
- Glycolic Peels
- Jessner & TCA Peels
- Micro-dermabrasion by Erbium Laser
- Natural Collagenisis (Roller Cit)
- Subcision
- Punch Excision, Punch Elevation & Punch Grafting
- Blood Injections
- Cool Touch, Gemini, IPL & PDT (Photo Dynamic Therapy)
- Fat Transplant
- Laser Resurfacing / Portrait
The Procedure
Affirm requires no messy lotions or creams for its treatment and takes approximately 15 to 30 mins to perform. As it is a ‘combined fractionated treatment’ it delivers treatment at two different depths in the skin simultaneously (1320 and 1440 wavelength). This precise microscopic thermal (heat) injury to the skin which resembles a mosaic pattern, rejuvenates the epidermis and outer dermis, and stimulates new collagen growth. Unlike true laser resurfacing that injures the full layer of skin and takes weeks to heal, the Affirm has minimal if any ‘downtime’ as the skin is continually cooled for comfort throughout the procedure.
Glycolic Peels are fruit acid (AHA) based preparations. The solution lightly buffs the skins surface removing and smoothing the outer layer of skin. This treatment can be effective for both active acne and if used over a longer length of time for acne scarring in some cases. Patients having glycolic peels are required to use a daily application of fruit acid solution or cream at home to increase the skin’s tolerance to the peel solution.
Jessner & TCA Peels penetrate deeper into the skins’ surface. Both peels are applied to the face in layers for best results and may require a few days to a week away from normal activities for healing.
Micro-dermabrasion by Erbium Laser is a quick and painless procedure. First a numbing cream is applied, then, the laser passes over the skin gently polishing and removing the damaged outer superficial layers of the skin.
Natural Collagenisis (Roller Cit) can be performed on either a small area or to multiple areas of the face by infusing the area with local anaesthetic for comfort. A special ‘roller’ is used to penetrate the skins surface which then stimulates the collagen producing cells (fibroblasts) to produce more collagen which helps smooth the surface of the skin.
Subcision is usually performed in conjunction with Natural Collagenisis. Under local anaesthetic, a small probe is inserted below the ‘depression’ or ‘divot’ of the acne scarring which breaks any underlying adhesion that may be pulling the skin down. An immediate slight visible lifting is usually seen.
Punch Excision, Punch Elevation & Punch Grafting are all techniques used to improve a small facial scar. In all procedures local anaesthetic is given for comfort.
Punch Excision involves the scarred skin being removed with a punch biopsy that gently cuts around the damaged skin leaving a small circular wound the size of the scar. The tiny wound is then stitched. Depending on the healing the new scar may be treated with a laser at a later date to minimize and improve the appearance of the skin even further.
Punch Elevation is best used in treating a depressed scar area when the skin is not significantly damaged. The small scar (usually less than 3–4mm) is elevated using a punch biopsy that gently cuts around the damaged skin. The skin is not removed. After being loosened from the depressed position, the skin lifts slightly to give a smoother appearance. The skin is usually covered with tape to keep the punched area in position.
Punch Grafting is used when a small scar is replaced with undamaged skin from another (donor) area. The new skin is usually taken from behind the ear. The donor site is closed with a few stitches and the recipient site covered with a small dressing.
Blood Injections involve using the patients’ own blood as a natural filling substance. Blood is taken from the patient’s vein (local anaesthetic may be used) and immediately injected under the scar where the blood instantly elevates the area. A laser is then passed over the area congealing the blood directly under the scar replicating the body’s own natural filler.
Cool Touch, Gemini, IPL & PDT (Photo Dynamic Therapy) are forms of laser and light treatments that can be used to manage mild to moderately active acne and acne scarring. Topical anaesthetic cream is not usually required. The Cool Touch is primarily used to stimulate collagen production to smooth the skin. The laser is passed over the skin and has the deepest penetration into the dermis to activate fibroblasts to produce collagen for scar improvement and can also minimize sebaceous glands that contribute to excessive oily skin and acne. The BLU light stimulates a photochemical reaction of light and heat, which activates porphyrin molecules that are found in acne bacteria. The reaction kills the bacteria causing acne and also acts as an anti-inflammatory agent. This effect can also be enhanced by the use of ALA cream.
Fat Transplant is a method where fat can be collected from an area of abundance on the body and transplanted under a scarred area to recreate natural filler.
Laser Resurfacing is the most invasive treatment of all the options. Full face or partial face lasering is designed to reduce the effects of scarring by vaporising the damaged outer layer of skin to reveal the smoother new skin below.
Recovery Process
Affirm has less downtime and less discomfort than other similar laser treatments with only slight redness and or minimal swelling that may occur for 8 – 30 hrs following the procedure. Most patients only require the skin to be cooled immediately after their treatment. Most results can be seen after a few weeks as it can take time for the stimulated fibroblast cells to increase their supply of new collagen.
Jessner & TCA Peels – Some degree of skin reaction for possibly five to seven days after the peel. Redness, flaking, scabbing or peeling to the skins’ surface are possible to varying degrees.
Micro-dermabrasion by Erbium Laser – Minimal redness may occur for 24 hours. Rarely, scabbing may occur, if so the scabs should lift within days and leave no scar. Cortisone cream may be applied to reduce any irritation.
Natural Collagenisis (Roller Cit) – The Roller finely pierces the skin creating multiple pin-holes causing localised bruising, swelling and an abrasive appearance to the skin’s surface. In most cases these symptoms settle within five to ten days. Immediately after the procedure a cream is applied and the skin is dressed with an adhesive dressing, which is removed the following day. Sun exposure should be minimized and returning to work largely depends on the individual, their occupation and lifestyle. Rarely infection can occur which can delay the healing process (prophylactic antibiotics are given routinely). Dr Rich also suggests treatment with the Cool Touch laser post needling to further stimulate the collagen formation.
Subcision – This causes only minimal bruising and swelling if performed alone as a single procedure.
Punch Excision, Punch Elevation & Punch Grafting – One week after the procedure all dressing and stitches are removed. The grafted sites may be raised at this point but are usually lasered one to two months later to smooth and merge the grafts to the surrounding skin. Make-up may then be worn.
Blood Injections – Initially some bruising and swelling may occur around the injected site. Long term, the aim is to stimulate collagen formation enough as to permanently raise any depressed area. Repeated treatments appear to produce further improvement.
Cool Touch, Gemini, IPL & PDT (Photo Dynamic Therapy) – Acne and acne scar treatments with the lasers produce little inconvenience to daily activities. Minimal redness may occur after treatment however this usually settles within 24 hours. As the laser’s effects occur deep within the dermis, results will be seen over a period of weeks to months as the collagen is slowly stimulated. Research shows treatment with the Cool Touch laser every two to four weeks either alone or in conjunction with the IPL for six to ten treatments greatly improves the effects of collagen reformation.
Laser Resurfacing – True laser resurfacing is a very invasive treatment. It requires an adhesive dressing to be worn for several days over the treated areas to protect the skin. Some initial swelling and oozing will occur in the first few days. After the initial healing, the skin will remain red and slowly return to a normal colour over a period of many weeks.
Portrait – This new technique offers many advantages for the appropriate patient. It requires no dressings, just a regime of special creams to be applied during the healing process. Although this treatment does not offer the same depth of improvement as true laser resurfacing, it is popular as the ‘downtime’ is less than resurfacing and the treatment can be repeated enabling nearly as much improvement as laser resurfacing by the Erbium laser.
With both Laser Resurfacing and Portrait treatments, camouflage make-up may be worn after the skin’s normal protective barrier has returned usually seven to ten days after the treatment.
Considerations
‘Down time’ (recovery time) must be taken into consideration when planning any treatments that may be close to patients social events.
Risks and Complications
Where necessary pre-operative medications are given to minimise any risk of swelling, pigmentation and the possibility of infection and or cold sores. Provided advice and medication is taken as directed, chances of complications occurring are minimised. Hyper-pigmentation or Hypo-pigmentation is rare, however with any of these procedures especially after laser treatments or the Roller Cit it may occur. Commonly patients with dark or olive skin tones are more affected.
Grafts may not survive in a transplanted position, this may be due to infection or that the site may have been dislodged with trauma or excess movement.
Faq’s
What causes acne?
No one factor causes acne. Most often in starts in puberty, but there are many cases of acne starting in the twenties as well as 30s, 40s and beyond. Acne is caused by a combination of genetic and hormonal factors leading to increased oil production by the sebaceous glands in the skin.
What doesn’t cause acne?
Acne is not caused by foods you eat. Despite what you may have heard, there is no proof that soft drinks, chocolate or greasy foods cause acne. Neither is it caused by poor hygiene. In fact if you wash your skin too hard or too often, you can make your acne worse.
Can my skin ever look like it did before I had acne?
It is important to understand that although there are many new treatments available that can rejuvenate and greatly improve the appearance of acne affected skin, unfortunately it is still not possible to completely return skin to its pre-scarred condition.
What is a fractionated laser treatment?
Simply, the Affirm delivers a precise microscopic mosaic pattern of micro thermal (heat) injury which rejuvenates the epidermis and outer dermis, and stimulates collagen. Unlike true laser resurfacing, that injures the full layer of skin which takes weeks to heal.
What is the Affirm?
The Affirm is a ‘combined fractionated treatment’ that is unique, as it delivers two treatments in one (both 1320 and 1440 wavelength) and is the first of its kind in Australia. We believe the new Affirm to be better than other fractionalised treatments currently available as they only operate in only one wave length. Other advantages are the Affirm has less downtime (slight redness for 8 – 30 hrs), and less discomfort than other systems available and does not require and pre treatments. We believe the new state of the art Affirm technology builds and improves on the previous technology of fractionalised lasers and delivers superior results.
