Acne Scarring Treatments: A Shared Journey Between Patient and Provider

Scarring caused from cystic, inflammatory acne leaves permanent textural contour irregularities of the skin, but can be a constant reminder to our patient of a time when embarrassing skin lesions plagued him or her, creating unwanted psychosocial ramifications. Today we have excellent treatments for mild to severe cases of acne scarring. However, in order for our patient’s journey to be a success, it is our responsibility as the provider to educate on three key components.

Firstly, there is a difference between hyperpigmentation or discoloration, and true scarring. The first is transient or temporary, and the second is permanent unless treated with the procedures discussed in this discourse. Second, if the acne is a more chronic condition, the underlying issue must first be addressed so that new scarring does not continue to result. Finally, the level of severity will determine the number of treatments ultimately required to achieve the desired patient outcome. If a patient presents with more severe scarring, multiple treatment packages can be expected, and it is advisable to educated our patient at the outset of his or her journey.

At the heart of all scarring is one common theme: loss of collagen. In some cases, there is formation of fibrous tissue, as well as color changes. But, there is always a loss of collagen. Thus, therapy aimed at neocollagenesis will prove effective. Patients should always be reminded that just as a baby requires nine months of gestation in utero, collagen also requires time, but typically around 3-4 months. In patients over 50, the expectation should be closer to 6 months for optimal results.

• Ablative Laser Resurfacing. Use of CO2 and erbium yag has long been utilized to target water in the skin, destructing the skin cells, thereby forcing new collagen. The CO2 can safely be used in skin types I-III, and the erbium yag in all Fitzpatrick skin types, but with proper skincare and protocols.
• Radiofrequency Microneedling has become the new gold standard for acne scarring. Currently there are 24 devices in the market, each with varying degrees of efficiency and individualized manufacturing characteristics. Once the needle grid is inserted into the dermis at the desired depth, the radiofrequency pulse is emitted. The provider can choose insulated needles or non-insulated needles based on factors such as the patient’s skin type and whether additional products such as platelet-rich plasma will be placed post-procedurally into the channels. Collagen will be induced regardless of whether add-ons such as PRP are placed on the skin. PRP is well known for its ability to decrease wound-healing times and improve outcomes.
• Microneedling has been employed for decades and made a resurgence ten years ago with the FDA approval of SkinPen. The biggest advantage to microneedling is its ability to stimulate collagen sans heat. However, since it is the radiofrequency aspect which gives microneedling such an impact when it comes to acne scarring, this procedure should be reserved for milder cases, and should always be performed in a series of at least three treatments. Adding platelet rich plasma will improve outcomes and wound healing times for these patients as well.
• Subcision is a technique to release the fibrous bands which pull scar tissue down. I only recommend this in conjunction with other procedures.
• Chemical peels are seeming to making their way out of favor when it comes to the diagnosis of acne scarring. They work quite well for pigmentation associated with acne. However, true atrophic acne scarring is best treated with RF microneedling and lasers due to the precision which one can achieve.

The treatment of acne scarring can be profoundly rewarding…if the provider partners with the patient. Expectations must be realistic. The skin will never be the porcelain skin seen in the magazines. But dramatic improvement can be seen. And what is more, the journey to realize results creates a lasting bond between patient and provider.

If you are a healthcare provider, check out Dr. Turner’s new website DrEllenTurner.com and sign up for her e-newsletter to receive tips, tricks and updates on injections, devices and life in this incredible but, sometimes overwhelming space we call aesthetic medicine.