The appearance of scars can be a cause for concern, particularly if they are located in prominent anatomic areas. An obvious scar can detract from an initial meeting or presentation. Fortunately, many scars can be helped with the use of intralesional injections of steroids, lasers, and topical dressings. The best treatment is often benign neglect, as time will generally be associated with a gradual fading of the scar.
Long after adolescence has passed, millions of people suffer from the long lasting effects of acne, namely acne scarring. Dermatologists are experts in the treatment of acne and acne scarring, though it would be unusual for ‘perfect’ results. Nevertheless, scarring can be treated with a variety of techniques that improve appearance and boost self-esteem. The choice of technique or combination treatment depends on the type of scarring, the patient’s medical history, and the expertise and lasers or other equipment available to the physician.
Acne scarring is a common condition which affects the appearance and confidence of many teenagers and adults. Because there are many ways to treat acne scarring, it is important that patients choose a cosmetic surgeon who is skilled in a wide variety of procedures, and someone who has access to appropriate devices, such as lasers, so as to treat these scars in an efficient and predictable manner. The same is true for other types of scars.
There are many different types of acne scars. Ice pick scars are deeply pitted, boxcar scars are rectangular or sharply demarcated, and rolling scars have an undulating appearance. Many patients require a combination of treatments for the best results.
Dr Zachary is recognized as a world leader in the management of scars, and has the most recent and innovative techniques and equipment needed to treat you. Dr Zachary and his staff will carefully evaluate your skin and develop a carefully planned treatment program.
Most scars can be improved by modern intervention. This might include surgical revision and excision, laser therapy, and intralesional or topical creams. For many patients, a combination approach is indicated. Not all scars improve dramatically with treatment, but our staff will take the time to explain to you the potential benefits and possible risks of treatment. The newer laser devices have dramatically increased the chances of significant improvement in many of these scars.
Rolling scars are often best treated with soft tissue fillers such as Juvederm or Restylane, which generally provide a nice improvement in the appearance of these skin undulations. Dr Zachary often uses these fillers in combination with other cosmetic procedures such as undermining the scar with a tiny blade or needle, a process called subcision. This process is often used under deep lines on the face in the nasolabial folds and under depressed scars, flaps or grafts. This type of scar may also be significantly improved with the new fractional ablative and non-invasive lasers such as the Fraxel Repair and Fraxel Restore lasers. Such devices have really changed the landscape of scar revision, and require little after care, and can often produce dramatic results.
Superficial boxcar scars can be improved with laser skin resurfacing, either fractionated or traditional, but deeper boxcar scars are often best removed surgically. Excision with stitches in combination with one of the various laser devices can induce impressive results. Boxcar scars also often respond well to fractionated devices, such as the Fraxel Restore or Repair lasers. Dr Zachary will work with you to develop a comprehensive treatment plan for acne scars.
There are two optimal treatment for these small depressed scars; surgical removal or focal chemical peel treatments. With surgical removal, as many as 15-20 scars can be removed in one session. Following the surgical removal of ice pick scars, most patients benefit from skin resurfacing using one of several lasers. The laser treatment is usually performed 4 to 6 weeks after surgical removal of the scars. Sometimes Dr Zachary will perform surgical excision of the scars immediately after laser resurfacing. Patients notice a nice improvement 4 to 6 weeks after the procedure.
Traditional laser resurfacing can be one of the most useful techniques in the treatment of acne scarring. Dr Zachary generally uses an erbium YAG laser for this procedure, but the CO2 laser is equally as good. These treatments tighten the skin to help smooth out the scars. Laser resurfacing is often combined with one or more other treatments for acne scars, and this combination can yield superior results compared to other therapies. Generally speaking, the ice pick and boxcar scars are removed first by surgical excision 6 to 8 weeks prior to laser resurfacing. Other surgical modalities such as subcision and the use of skin fillers (Juvederm, Restylane, Radiesse, Sculptra, and fat) are also invaluable. For those who are interested in less aggressive laser treatments with shorter downtimes, you might consider the fractionated ablative or non-ablative resurfacing devices. For more information about traditional and fractionated laser resurfacing, see the “Laser Skin Resurfacing” and “fractionated laser” links.
There are two entirely different classes of fractionated devices that Dr Zachary utilizes, fractional ablative and fractional non-ablative.
Examples of the fractionated ablative devices would be the Fraxel Repair, the Sciton ProFractional and Cutera Fractional Pearl. These vaporize the skin in a fractional manner, meaning that they create myriads of tiny very narrow cylinders of vaporization to a depth of about 1.5 millimeters over the entire face. Each area of vaporization is surrounded by entirely normal untreated skin. This allows these damaged zones to heal very quickly, and without scarring.
Examples of non-ablative fractional devices would be the Fraxel Restore and the Cynosure Affirm. This procedure is similar in that it is fractionated with tiny areas of coagulated tissue, but without vaporization. It is a much gentler treatment, and is associated with less downtime after treatment. Performed as a series of five or six treatments about once a month, Fraxel Restore laser treatment helps to smooth acne scars and fine to moderate wrinkles. Sunburn-like redness and swelling for a day or two are usually the only after effects of this exciting new procedure.
Think of a device that sandblasts grime and debris off granite buildings, and you get an idea of microdermabrasion, with the emphasis on ‘micro’! Small particles passing through a vacuum tube remove the top layer of the skin and are said to stimulate new cell growth. Dr Zachary is not super impressed with the long term benefits of microdermabrasion alone for acne scarring, but it can certainly help when used in combination with other topical agents such as Retin-A, bleaching agents, and other rejuvenating creams. Because of the superficial nature of this technique, patients with mild scarring are the best candidates, and multiple treatments are usually required to achieve subtle results.
The latest development in microdermabrasion with the DermaSweep device gives much for significant results. It uses a nylon or steel brush infusion technique which gives surprisingly good results in patients with mild to moderate acne and acne scarring.
Mild acne scarring and certain types of acne may be successfully treated by the application of a chemical peel solution. This allows new and regenerated skin to appear, improving the appearance of the condition.
Given the plethora of devices at Dr Zachary’s disposal, patients are fortunate to have access to the best of all worlds. Dr Zachary is an expert at removing deeper scars and making them dramatically less noticeable. This approach is associated with results that are consistently excellent, and sets a new standard for care in this area.