Before we discuss the subject of acne scars and the various injectable treatments that are performed in a clinic setting, let’s have a quick look at what acne is.
Acne vulgaris is a universal skin disease affecting many of us from teenage to early adulthood and beyond. In fact, it is the eighth-most common global disease, affecting nearly 10% of the population which causes scarring in up to 95% of sufferers.
Effective management plays a vital role to minimise the risk of scar manifestation as inappropriate or no management may lead to scarring depending on the acne grading.
Acne scars are permanent indentations in the skin that result in textural changes as a result of severe or untreated acne
The type of acne scarring may vary. These include atrophic scars which are formed due to the production and the degradation of collagen during the healing pathway. In almost 90% of those affected, there is a net destruction of collagen in the dermis leading to the formation of such scars, as opposed to a net gain of collagen which is less common leading to the formation of hypertrophic or keloid scars
Atrophic scars are divided into three categories these are
The ice pick type scars present in 60%–70% of total scars whilst the boxcar scars are between 20%–30%, and rolling scars comprise 15%–25%
|Icepick||Narrow scars, 2 mm in depth with a wider opening giving a V shape|
|Boxcar||Round or oval in appearance with defined edges and varying depths. They are U-shaped.|
|Rolling||Greater than 4 to 5 mm in width. These scars give a rolling rippling M shaped appearance with reflecting a superficial shadow on the skin|
If you feel like your skin is impacting your confidence, you are not alone. Thankfully there are options that can address acne scarring so never feel that it is too late.
Acne Scar treatment options:
Management options vary depending on the type of scar that is being treated.
So, how can differentiate between post-inflammatory pigmentation (PIH) as a result of due to acne or genuine acne scarring?
Post-inflammatory hyperpigmentation (PIH) as a result of trauma to the skin which in this case is acne tends to present as dark patches that are left on the skin following an acne breakout. These tend to fade naturally, and there are products that may facilitate the process.
However, acne scarring usually causes textural changes in the skin as a result of the disturbance in the collagen level in the skin during the wound healing process.
The simplest way to differentiate between the two is by touch. Therefore, patient assessment and identification of the type of acne scar are vital to the treatment outcome as not all scar types respond to all treatment modalities, and therefore there is a need to adopt a systematic approach using a defined algorithm
These are divided into four categories.
- Temporary which are composed of cross-linked hyaluronic acid fillers. hyaluronic acid is a glycosaminoglycan polysaccharide (GAGs) and a physiologic component of the extracellular matrix ECM. These stimulate collagen production by fibroblasts, augmenting soft tissue and improving the quality of the overlying skin, they last for a few months, therefore repeat treatments are needed
- Semi-permanent- Composed of Poly-I-lactic acid (PLL) with a trading name of Sculptra® as one example. This has a bio stimulatory effect and is demonstrated to improve acne scarring, especially rolling scars. Calcium hydroxylapatite (CaHA) on the other hand, is a synthetic filler, known as Radiesse® that have demonstrated improvement in boxcar scars when used alone or a week post scar suspicion
- Permanent such as Bellafill®(previously named Artefill®) received FDA approval “for moderate-to-severe, atrophic, distensible facial acne scars on the cheek in patients over 21 years of age.
- Collagen fillers- Collagen fillers should not be used in patients with autoimmune diseases or collagen hypersensitivity. Soft-tissue augmentation usually persists for up to 6 months. The use of collagen fillers for atrophic acne scars was recommended by the American Society for Dermatologic Surgery.
In practice most commonly used are the temporary dermal fillers as they carry less of a risk compared to the above three.
Hyaluronic Acid Dermal Fillers:
This is the most common type of temporary dermal filler. Hyaluronic acid occurs naturally in the human body and is found almost everywhere such as the valves of the heart, the joints, and the eyes but mostly in the skin. In fact, 50% of hyaluronic acid is found in the skin. in many hyaluronic acid dermal filler injections smooth acne.
Cross-linked hyaluronic acid in dermal fillers is used to augment soft tissue, especially in soft atrophic rolling or boxcar scars. There are different types of injection techniques that are used which include serial punctures, linear threading, fanning and cross-hatching, deep bolus, and superficial micro-droplet injections. This method of treatment is well tolerated, however, common side effects include may include infection, pain, erythema, lumps, swelling, and abscess formation
The downtime from hyaluronic acid dermal fillers is minimal and results last for at least six months.
Platelet-rich plasma (PRP)/The Vampire Facial:
This is sometimes known as the ‘Vampire Facial’ which utilizes the body’s own blood which is taken out in exactly the same way as when you have a blood test.
The blood sample is placed in a special test tube and spun in a centrifuge to separates it into layers of platelet-poor, rich and red blood cells. The important part is the platelet-rich part which has the regenerative value. Red blood cells function to carry oxygen and have no regenerative value, so beware of the marketing that you see with red blood smeared all over the face. It is messy and not necessary.
level one evidence suggests that PRP may improve the quality of atrophic acne scars treated with ablative fractional CO2 laser thereby reducing the duration of laser linked side effects including oedema and erythema skin reactions owing to the PRP’s ability to deliver a high concentration of growth factors to target tissues leading to better healing.
Collagen Induction Therapy (CIT):
PRP can also be administered via microneedling also known as Collagen induction therapy. Microneedling is commonly known as collagen induction therapy. This is a simple, inexpensive treatment for the management of post-acne atrophic scars.
This treatment involves the use of dermaroller or a fractional pen which is an electric device to deliver key ingredients into the skin as it induces the production of collagen.
Collagen III is the main type of collagen formed in the early wound healing phase. It is gradually replaced by collagen I over time. Collagenases and matrix proteinases are involved in the gradual conversion of collagen III into collagen I. The advantages are that the epidermis remains intact, minimizing risks and side effects as compared to laser treatment modalities.
We perform this treatment in our clinic and it is one of the most loved treatments as it is a workhorse that treats a multitude of skin concerns including sun damage, large pores, uneven skin tone as well as fine lines and wrinkles.
All miconeedling treatments performed at DermRefine Skin Clinic are combined with a mesotherapy cocktail to maximize your treatment.
An emerging concept that is gaining more and more coverage is platelet-rich fibrin (PRF) which uses the same principle of PRP by taking the blood from the patient and spinning it. However, the spin cycle differs and the tubes are also different
This procedure has been shown to produce better yields of platelets, in fact, it yields double that of PRP. It is totally natural as the tube has no activating material that is needed for PRP tubes. As the spin cycle is different than PRP it spares the platelets from being destroyed and produces a fibrin mesh which in itself acts as a temporary scaffold in the skin whilst allowing collagen production to take place.
We absolutely love PRF and more evidence is emerging that it is more favored than PRP. For more information, check out the PRP procedure on the advanced skin section of our website
Mesotherapy for Acne Scars:
Mesotherapy scar removal treatment is effectively simple and safe. Acne scars can be unsightly and may play a role in the decline of confidence.
Mesotherapy treatments work by filling the scarred areas with nutrients and powerful ingredients where noticeable results may be seen within 3-4 sessions.
Mesotherapy treatment for scars is quick and easy, with each session lasting around 30 minutes.
The number of treatments varies, depending on the severity of the scarring. Normally, micro-injections are administered every two weeks until a maintenance program is reached.
Mesotherapy treatment has no downtime. During the treatment, the client may experience a slight burning feeling but this tends to disappear within 15-20 minutes post-treatment. Some bruising and swelling may occur within the next 48 hours
Check out our skincare treatments section for more information on how mesotherapy works for you.
Botulinum toxin/ Botox:
Botulinum toxin which is often referred to as the trade name Botox has a role in treating scars that happen to lie in an area where they are exaggerated by movement and there will be no untoward cosmetic effect on the patient. Scarring in the upper face (forehead, periorbital, glabella) and the lower face (chin and surrounding areas) tends to be well-targeted by botulinum either alone or more usually in combination with other techniques such as fillers, resurfacing, and surgery
Botulinum toxin may be combined with fillers at the same session, or as is more common, fillers are employed two weeks later, once the effect of botulinum is achieved. Over a period of time, the recurrent action of the muscles on the skin is weakened by atrophic scarring and may force the skin to fold unnaturally, pronouncing the appearance of the scars. As the atrophic skin poorly resists the muscular forces, the natural folds become less natural leading to the look of premature aging skin. If this continues static lines will be forced into the skin, deepening them over time. Releasing the action of these muscles may immediately help the appearance of the skin. Dermal fillers may further augment this process by
targeting these imprinted lines, providing further assistance if the botulinum toxin has not achieved the desired outcome in reducing the appearance of the scars.
For more information on how Botulinum toxin, click here to visit our Wrinkle Reducing treatments.
This treatment involves the use of microchanneling devices such as Aquagold Fine Touch, and other similar brands to address acne scarring. The chamber consists of 20 gold-plated needles that are thinner than the human hair to deliver a cocktail of formulated ingredients directly to the target area. Such ingredients may also include botulinum toxin and dermal fillers.
There is no downtime with micro-infusion treatments and the results can last up to three to four months.
Check out our page in the advanced treatment section for DermInfusion/ Aquagold Baby Botox for this revolutionary treatment.
The purpose of this treatment is to address raised hypertrophic, or keloid, acne scars that can be treated with cortisone steroid injections, which work to flatten the scar by breaking down the bonds between the collagen fibers.
Treatment downtime is minimal, and a course of around six injections is usually needed to get the best results. However, there are risks attached to steroid injections so it’s important to discuss this option with a professional before making any treatment decisions.
So, what is the best treatment for acne scarring?
There is no such thing as the best type of treatment. individuals are different and the presentation of their concern may vary in severity. Therefore each patient is unique.
However, there are multiple management options for the treatment of acne scarring. These are comprised of a medical, topical, injectable, laser, and well surgical performed as stand-alone or in combination.
The take-home message is that selection and detailed assessments are paramount for an effective and safe treatment journey to progress.
We may start with one treatment but as the treatment journey commences, we may need to alter the path or introduce an additional treatment option to the plan to manage the changes in the scar pattern. This may also include laser resurfacing treatments.
Knowledge, skill, and experience of the practitioner performing the procedure play a vital role in identifying the type of scarring to opt for the most suitable treatment option as one formula does not fit all.
Thank you Etro Vous for inviting me to contribute to their article regarding injectable treatments for acne scarring: https://www.etrevous.com/blogs/treatments/treatments-aging/can-injectables-erase-your-acne-scars
For more information and to arrange a consultation regarding any of your skin concerns, head over to Etre Vous/ Aesthetics where I am more than happy to see you for an online virtual consultation or