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                                                                                         Fraxel 2 Sessions

Every day I treat people for acne and acne scarring.  Luckily there very effective treatment options available to improve the appearanceof acne scars. There are also some treatment myths that need to be cleared up.

1. The first thing I always address with my patients is whether they are still breaking out, if you are still getting acne lesions, you first need to get control of the acne. Otherwise, new scars will be developing, and money and effort will be wasted to treat scars without doing anything to prevent new scars. I make a point to make this clear to my patients, because I believe it is important in order for the outcome to be the best possible.

2. The top 3 treatments I believe work the best for acne scarring are the Fraxel (a fractionated resurfacing laser), the pixel (which is a CO2 laser), and microneedling. The Fraxel will take 3-5 treatments, but has a relatively quick recovery, it creates “micro” perforations in the skin with spared healthy skin in between these areas, so the skin heals quickly. Patients will have redness after a treatment, similar to a sunburn, but this resolves usually over 3-7 days, and makeup may be worn. The CO2 laser which is often used together with an Erbium Yag laser, is similar to the Fraxel but is slightly more invasive, with most patients only needing 1-2 treatments. This laser treatment does require a recovery period of 7-10 days, with frequent application of ointments to the face until completely healed. Microneedling pens are gaining popularity for acne scarring. They are mechanized tool with fine needles which are used over the areas of scarring, creating perforations mechanically. The outcome is very similar to results seen with fractional lasers, with less redness and shorter “down time”, this may be a better option for darker skin types than a laser – offers a reduced risk of post treatment hyperpigmentation.

3. A lot of people ask me what kind of creams should they purchase. The ingredient that is most helpful in the treatment of scarring is retinoic acid or retinol. Retinoic acid comes in many different formulations from the generic tretinoin, to well-known brands such as Retin A, Renova, Tazorac or Atralin. Retinoic acid/Retinol containing creams can help stimulate new collagen production. Used in a pea size amount in the evening, these creams are usually very tolerable. It is a useful medication to treat the acne and acne scarring together.

4. Get a dermroller. If you haven’t heard of a dermroller, imagine a roller with numerous fine needles, this is used to roll over the surface of scars to create small perforations similar to the lasers. These small injuries to the skin heal with new collagen in the areas treated. Out of curiosity, I myself purchased a dermroller, and I cringed in anticipation of pain prior to using it on my cheek…I was surprised that it actually tickled/felt like mild scratching. The needles come in different lengths, I would recommend starting out with a shorter needle, the 1mm, and working up to a longer one. Topical numbing creams are usedfor the longer needle rollers, and the depth of treatment is controlled by the amount of pressure being used when you press down on the rollers. If the roller is used 1-2 times per week, over the course of several months the texture of the skin and scarring can be greatly improved.

5. Chemical peels were historically among the first treatments available for scar treatments, but now with advances in technology I generally don’t recommend them in my practice for the treatment of scarring. The reason for this is that in order for a chemical peel to be useful in the appearance of deep acne scarring the peel has to be very strong. A strong peel, such that would be necessary for deep acne scarring should only be used in a very fair skin type, otherwise this can be very risky for skin discoloration and scarring. Because of their limitations of use for lighter skin types, it becomes prohibitive to other patients. It can take many peels in order to see results, meanwhile only several laser treatments would have been necessary to achieve better results for the same price. That being said, I do use chemical peels routinely with great results: for discoloration/hyperpigmentation and dull complexions.

6. Time! Time has a role in the treatment of scars, a new scar will often have a red appearance to it. And this can take time to improve. There is a delayed healing process that occurs after a scar treatment has been administered. It can take 3 to 6 months to see the full effect of a treatment, this is because there is a slow tissue remodeling process which occurs with new collagen and elastin being produced in the areas treated. This is why good photographs are so important! Often patients even forget how their skin looked prior to starting their treatments, and are very encouraged when they see how much they have improved.

7. Filling pitted acne scars with fillers. Injectibles, such as Restylane (a hyaluronic acid based filler) or Artefill (human collagen based semi-permanent filler) can be used to fill select pitted and boxcar acne scars. The advantage is that the results are instant, without the long wait for tissue remodeling.The drawback is that it is usually not permanent, will not address the textural component of the scarring or skin tone.

If you are interested in what would work best for your skin see your Dermatologist for the best fit for your needs. Scarring does not need to be newer in order to be amenable to treatment, the oldest of scars can still be improved!

Dr. Kally Papantoniou, MD, FAAD

Board Certified Dermatologist: Cosmetic & Medical

Advanced Dermatology Laser & Cosmetic Surgery

Mount Sinai Dermatology Clinical Instructor