Acne Scarring Treatments in Fresno
Acne is the bane of just about every teenager, but it can last into the adult years, as well. Common acne, clinically known as acne vulgaris, not only impacts the patient’s self-esteem during a breakout, but it can leave permanent damage through scarring. Dr. Behr has extensive experience in improving acne scarring, and she continually seeks new treatment options.
Why does acne cause scarring?
Acne scarring is the term for permanent textural changes and indentations left on the skin as a result of severe acne. Scarring does not refer to red and brown marks left after a breakout, as these invariably improve without treatment.
When clogged pores swell as the bacteria multiply and cause increasing inflammation, the follicle wall eventually breaks. If these breaks are shallow, the lesions created are minor and can heal themselves through normal skin processes. But if there is a deep break in the wall of the pore, infected material can spill out into surrounding tissue, creating deeper lesions. The skin produces new collagen fibers in an attempt to repair this damage, but these repairs on deeper lesions aren’t as smooth as normal skin and pits can remain permanently.
Will all acne cause scarring?
There are different types of acne. Acne vulgaris is common in virtually all humans at one time or another. Acne fulminans is a rare but very severe form that comes on abruptly in adolescent males creating hard nodules on the face and back. Acne mechanica is triggered by excess pressure, heat, and friction on the skin. This form is common among athletes wearing chin guards and the like.
It’s not the type of acne that matters; it’s the type of lesion that leads to scarring. These are the different lesion types:
- Blackheads: These are uninfected, clogged follicles that appear as dark bumps on the skin.
- Whiteheads: These are clogged follicles covered by a thin layer of skin, allowing the clogged pore to show through.
- Papules: These are inflamed lesions that may appear red and can be sensitive to the touch.
- Pustules: These are inflamed lesions that are filled with pus. They may appear white or yellow. Popping pustules can lead to acne scarring.
- Nodules: These are severe acne lesions that develop under the skin but do not contain pus. They are hard to the touch.
- Cysts: Cysts are the most severe form of acne lesions. They are inflamed and filled with pus. These lesions will leave scars.
What are the types of acne scars?
Acne scars fall into two main types: hypertrophic/keloid or atrophic/depressed. Keloid scars are known more for larger wounds, but they occur with acne cysts and pustules as well. They result from the body producing too much collagen to heal the lesion, resulting in an area of raised tissue. Depressed scarring develops where there is a loss of tissue.
These are the types of acne scars and their descriptions:
- Box car scars — Shallow to medium in depth with well-defined edges, box car scars are common on the cheeks and temples.
- Ice pick scars — These are deep and narrow scars that extend into the lower layer of the skin
- Rolling scars — These appear as undulations and depressions on the skin. These scars may be anchored to deeper structures, so the goal in treatment is to free the bound up tissue and fill the depressions with new collagen.
- Macular scars — These red scars are a result of early acne scarring. This type doesn’t create a loss of skin, and it will usually fade away over 6-12 months. Laser can help redness fade more quickly.
- Hypertrophic scars — These are the raised keloid scars that are common on the jawline, neck, chest, and back.
Do certain acne treatments cause acne scarring?
Medications and acne products can have different levels of success calming and treating acne breakouts, but these products don’t cause scarring. Acne scarring is simply a result of clogged pores breaking down. Popping pustules can spread bacteria around the area, actually worsening the breakout. So, popping pimples could lead to additional scarring.
Laser treatments can either be ablative or non-ablative. Ablative procedures use laser energy to remove thin layers of skin, which then exposes healthier, scar-free skin beneath. Ablative treatments require recovery time. Non-ablative treatments are non-wounding. The laser energy stimulates collagen growth and renewal. They require little if any recovery.
- Fraxel DUAL fractional resurfacing — Dr. Behr uses two Fraxel Lasers for these fractional treatments: 1550 and 1927 wavelength options. Fractional lasers are best for atrophic and rolling acne scarring. These lasers create hundreds of microscopic channels through the epidermis down into the skin’s second layer, the dermis. These tiny punctures heal within a couple of hours, but they trigger a wound response in the body. This response is to produce new collagen to “heal” the wounds. A series of Fraxel treatments is usually needed to gain the level of acne scar improvement most patients seek. There isn’t any real “recovery” time with fractional treatments. Depending on the level of treatment, patients may have some redness and minor swelling, but this passes quickly. The skin will bronze for a couple of days after the session, and then lightly flake and exfoliate.
- UltraPulse CO2 laser resurfacing —The CO2 laser energy ablates the surface skin down to a set depth. Dr. Behr has been performing CO2 laser resurfacing for over 20 years, so she has extensive experience. These ablative treatments require a recovery time of 7-10 days, and there will be some swelling and crusting of the skin. Typically these are single treatments.
- PicoSure laser skin revitalization — The PicoSure laser delivers ultra-short bursts of laser energy, which creates less possible damage to the skin. Instead, the laser energy enters the dermis and remodels the collagen. The FDA has approved the PicoSure laser for acne scarring. There isn’t any recovery from these laser treatments. Patients may have some redness for a day or so following treatment.
- Microneedling with PRP — The SkinPen by Bellus Medical uses a sterile needle-tip containing 12 tiny micro-needles to create controlled micro-injuries to the skin. This stimulates the skin’s repair process to naturally produce collagen and elastin. The micro-channels created by the treatment allow for optimal absorption of topical products and Platelet Rich Plasma (PRP), enhancing the effects in the deeper layers of the skin.
These treatments deliver radiofrequency energy through the epidermis down into the dermis layer. This RF energy converts to heat in the dermis, and this heat triggers a wound response, which remodels the current collagen and initiates production of new collagen.
- Vivace microneedling with RF — Dr. Behr combines microneedling with the delivery of radiofrequency energy with Vivace. Microneedling has long been used to rejuvenate the skin. It uses a pen-shaped device with 12 microscopic needles that create hundreds of channels through the epidermis into the dermis. As in fractional laser treatments, these channels begin to heal immediately, but they trigger new collagen production, plus they break down scar tissue. The Vivace device adds RF energy, which further stimulates skin renewal. The tips of the 12 needles deliver RF energy directly into the dermis layer of the skin when the needles create their tiny punctures. As with laser energy, when radiofrequency energy enters the dermis the body thinks there has been a wound, so it initiates wound repair and skin renewal. There is some redness and slight swelling after a Vivace session that lasts about six hours.
How many treatments will I need to improve my acne scarring?
These various treatments all have different levels of aggressiveness. CO2 lasers are usually only a single treatment. The other options vary. Plus, each patient has different rates of scarring and skin renewal. When we see you for your consultation, Dr. Behr will discuss your options and the likely number of treatments necessary for your unique situation.
More Acne Scarring Treatments
Punch excision or subcision of deep icepick or box car scars can be done by one of our providers before laser treatments. Filler can be used to help lift shallow scars at any time.
Is there a way to avoid acne scarring?
It’s estimated that 10 million Americans develop some degree of acne scarring every year. The key to preventing or lessening any acne scarring is to aggressively treat acne as it develops.
At Behr Laser & Skin Care Center, we offer a variety of products for treating acne. Some of the most effective are topical retinoids. Dr. Behr can also suggest other products and treatments. If necessary, she is able to prescribe isotretinoin (commonly known as Accutane).