At Bulimba Dermatology you will have an appointment with a dermatologist to initially assess the type and severity of acne scarring that you have. This will enable them to determine the best type of treatment for you, based on your skin type.
There are different types of acne scars. These include:
- ice pick scars – sharp, pointed, pitted scars
- boxcar scars – broader pitted scars
- rolling or atrophic scars – depressed, flat undulating scars
- keloid and hypertrophic scars – thick, hard, lumpy scars.
There are often reddish purple marks left after acne has been treated. In many cases this is not scarring, but post-inflammatory erythema or pigmentation, and will fade with time and healing.
Most acne scars will require more than one type of treatment and multiple treatment sessions to get the best results. The dermatologist will discuss your scarring with you and will recommend individualised treatments to offer you the best chance of improving your acne scars.
At Bulimba Dermatology we have a specific approach to the treatment of acne scarring.
TCA cross treatment
This is a highly specialised treatment for deeper acne scars such as ice pick scars and smaller boxcar scars which do not respond as well to other treatments including laser treatments. The procedure involves the precise application of a concentrated acid (trichloroacetic acid or TCA) onto the base of the scar. One scar at a time is treated in a procedure taking around 30 minutes. The patient will experience a moderate tingling or warming sensation on the skin being treated. This is usually well tolerated. Sometimes a fan or cooling device is used to make patients more comfortable.
At the end of the treatment, the areas of skin that have been treated turn white and the surrounding skin is slightly inflamed. Some further redness and swelling can develop later on the day of treatment.
Healing takes place over one to two weeks but often a further one to two weeks is required for the skin to return to its natural colour. Very careful care of the skin is required following the treatment. Your dermatologist will explain this.
Subcision, punch excision and punch elevation of scars
Sometimes a minor but highly specialised surgical technique called subcision is performed to treat broader rolling scars that are often bound-down to the underlying skin structures. This technique is an excellent and safe treatment for the right scars. Initially the area to be treated is made numb with a local anaesthetic. The dermatologist then inserts a surgical needle under the skin and manipulates it to release tethered scar tissues and elevate the scars back to normal skin level. This procedure also stimulates new collagen formation under the surface of the skin, which further lifts the scar. Improvement occurs over several months following the procedure. It is often the perfect treatment before collagen fillers and laser treatments are performed on scars to maximise the improvement achieved. Recovery from this procedure is often within a week, with usually only minor bruising and swelling experienced.
Small but very deep scars are often effectively treated with punch excision or punch elevation. Again, following numbing of the skin with local anaesthetic a special device is used to “punch out” the scar. A fine surgical suture or stitch is then inserted resulting in a very small, fine surgical scar replacing the acne scar. This surgical scar can then be more easily treated with resurfacing lasers than the original acne scar.
Laser technology has developed rapidly over recent years and the use of lasers for the treatment of acne scars has now become a very specialised area of dermatology. Many non-dermatology “laser” clinics offer laser treatments for acne scarring but often do not have the training and expertise, or fundamental knowledge of the skin and scarring process, to produce the best results.
Laser treatment is not suitable for everyone. Advances in laser technology, such as fractional laser, have allowed treatment of more patients with much quicker recovery time (downtime) and improved safety profiles. It is important for patients to have realistic expectations of what benefits can be achieved, as well as the possible risks and side effects associated with these treatments. Helping you to understand these points is part of our role at Bulimba Dermatology when guiding you towards the best treatments for your acne scarring.
It is common for patients to experience red areas on their skin following acne. It is a common misconception that this redness or inflammation is active acne. This redness is often not active acne but a condition called macular erythema. It will generally fade naturally over a number of months. However, in some cases, a vascular laser can be used to speed up nature’s healing process and reduce the redness of these blemishes. Your dermatologist at Bulimba Dermatology will offer you guidance on treating post-acne redness.
Dermal fillers are best used in rolling scars, often following other procedures such as subcision or laser resurfacing. Fillers work by physically lifting and flattening depressed scars resulting in a more even skin surface. The procedure of injecting the filler can also stimulate the body’s own collagen to be formed, further lifting the scarred skin. Fillers can reduce scars by 50% or more but the treatment needs to be repeated after 12 months or longer to maintain the improvement.
At Bulimba Dermatology your acne scarring will be treated by a dermatologist. Medicare offers substantial rebates if a qualified dermatologist is treating your acne scars. Discuss this with your dermatologist.