Acne scars are a notoriously difficult problem to treat. Many older therapies relied on deep removal of layers of skin, long healing times, and potential pigmentation (skin color) difficulites. In addition, many of the older therapies could not be used in darker pigmented patients. Luckily, over the last several years, some new and exciting acne scar therapies have come to fruition. Dr. Shah offers the latest in acne scar treatments.
Dr. Shah uses a symbiotic approach to acne scars. He has found that more than one mode of treatment provides the best results. This approach involves switching between techniques to avoid acne scar plateau.
Post-acne scarring is quite common. An atrophic acne scar is where permanent, postinflammation degradation of the dermal surface. About 95% of acne patients will have some degree of acne scarring. Acne scarring tends to look worse with aging.
There are said to be three different phases of acne scarring:
1. Inflammation- this is where inflammatory mediators are brought about and swelling and localized inflammation is seen.
2. Granulation Tissue Formation-
3. Matrix remodeling- imbalance of metalloproteinases and mmp inhibitors
The scars occur as there is degradation of collagen fibers and subcutaneous fat. There is also thought to be a genetic disposition of some patients to scar versus others.
ACNE SCAR TREATMENTS
CROSS (CHEMICAL RECONSTRUCTION OF SKIN SCARS)
CROSS is a new approach to acne scars. Using the strength of a deep peel, Dr. Shah selectively targets acne scars while sparing the remainder of the skin. He treats specific scars in a highly technical and specific manner. The stimulation of the deep peel encourages collagen formation, flattening acne scars and improving skin texture. The benefit of targeted selection is that the recovery period of chemical peel is limited to the treated areas. In addition, many drawbacks of deep chemical peels can be avoided including pigmentary abnormalities, erythema, and scarring. This technique can be used in all skin types including Caucasian, Asian, African American.
CROSS TCA works with specific types of acne scars. Icepick, pores, and some boxcars respond best to this approach. Recovery from this technique often involves the early formation of a white spot which is replaced by a scab. The scab falls off and then underlying redness can be seen in the area treated with the CROSS TCA. The redness typically dissipates in a week but can last longer in select patients. Patients typically repeat multiple treatments for optimal results.
MEDICAL ROLL CIT
The medical roll CIT (collagen induction therapy ) is a procedure developed to promote collagen deposition in the dermis, just below the surface of the skin. It is an effective procedure for acne scarring and upper lip wrinkles.
The developers of the medical roll CIT found that tattooed skin was smoother than non-tattooed skin. They found that the stimulation of the needles created focal areas of stimulation to the dermis, inducing the creation of collagen. In order to further stimulate collagen, topical vitamin A and C are applied before and after the roll CIT therapy. Vitamins A and C can more effectively penetrate the deeper layers of the dermis after medical roll CIT session.
While other modalities target collagen by removing lasers of skin, the Medical Roll CIT can stimulate collagen while leaving the majority of the superficial skin intact. The benefit to the patient is less pain in recovery, quicker recovery, and less chance of scarring or pigmentation changes than ablative skin therapies. In addition, the medical Roll CIT can be used all skin types safely.
The roll CIT is a highly stimulating procedure which requires a combination of a light sedative, anesthetic blocks and topical anesthesia. Most patients opt to have this procedure done in the office setting. Recovery involves swelling and in some cases bruising which typically resolves over a period of 4 to 5 days. Medical Roll CIT is effective in all acne scar types.
Dermabrasion is an older technique, yet still effective in select types of scars. Dermabrasion works by removing the superficial layers of skin with a diamond burr. When the skin heals, it will be smoother and scars may be less visible. Deep scars and ice pick scars are not good candidates for this type of therapy. Darker skin types are also not good candidates for this therapy. Most patients use dermabrasion as a "finishing" procedure once they have adequately stimulate collagen.
Lasers can be helpful in improving texture and lessening scars in some patients. They are an alternative to dermabrasion. Dr. Shah uses a combination of erbium, fractionated erbium, C02, and fractionated C02 to resurface the face. A laser is a relatively superficial resurfacing modality but can improve texture with multiple treatments.
Subcision is when deeper scars are released with a needle and relies on blood and body fluid to lift scars to surface of skin. Unfortunately, this technique can have drawback of unpredictable nature and temporary lifting of scars only to have them become depressed again. Dr. Shah utilizes a different approach where he subcises the skina nd then uses fine sutures to maintain the improved skin and scar position. He also subcises skin and maintains position with dermal fillers to allow for the newly positioned skin to heal in a flatter configuration.
TYPES OF ACNE SCARS: Just as there is more than one type of acne scar treatment, there is more than one type of acne scar. See more about each type. Read more.
Goodman and Barron Classification of Acne Scar Severity
Grade 1 Maccular scarring or flat scarring that is charcterized by flat area of increase or decreased pigmentation visible from a distance of >500mm
Grade 2 Mild disease that is visible at distances of >500 mm and can be covered up by make-up
Grade 3 Moderate disease that is visible at > 500 mm and is not easily covered up by make-up or the normal shadow of a shaved beard. Stretching the skin can flatten the scar.
Grade 4 Severe disease as in Grade 3 but is not flattened out by stretching the skin
The Science Behind Acne
Acne is a common skin inflammation. When hair follicles or pores in the skin get trapped, the acne bacteria (Propionibacterium acnes) multiply in the pit and become inflamed. There are many other factors in the acne story such as hormones. When hormonal changes at puberty create excess oil, pores become blocked and are an open invitation to Acne bacteria. Commonly, patients are placed on systemic agents such as birth control antibiotics or oral antibiotics. The problem with such treatments is that it effects the entire body, can be cumbersome and inconvenient to the patient. In addition, long term systemic antibiotics can lead to antibiotic resistance.
The Intense Pulsed Light System works by two mechanisms. First of all, by reducing oil gland function while reducing the amount of the Acne bacteria. When used in combination with an enzyme peel which helps exfoliate and open the pores, acne can be dramatically improved. Intense Pulsed Light treatments are revolutionizing the treatment of acne with easy, quick and effective treatments to suppress acne without the problems associated with systemic therapies. Finally, your acne treatment is not complete with a skin care home regimen customized to your skin, age, and problematic skin.
ARTICLES: Dr. Shah has authored over 50 scientific articles. All of the articles on this website have been authored or co-authored by Dr. Shah. His unique viewpoint about facial plastic surgery are highlighted, with several of the articles published exclusively for Plasticpedia. Browse now.
ETHNIC FACIAL PLASTIC SURGERY (EFACE): The term "ethnic" is often used to describe any patient who is of non-caucasian origin. Most patients are seeking improvements that work with their facial features and ethnicity, not to change their racial identity. Dr. Shah has subdivided ethnic plastic surgery into a few backgrounds because the differences between the ethnic characteristics can be quite large. Read more.
PROCEDURE TIMELINE: Many patients ask at what age can a patient have acne scar treatment (or another procedure)? This timeline is intended to serve as general information on the ages at which patients may seek a procedure such as acne scar treatment. See more.
LEARN TO SPEAK THE LANGUAGE OF FACIAL ANATOMY: Understanding your facial feature and how they age can seem daunting. Use this guide to help to know your jowl from your pre jowl sulcus or your nasal labial fold from your marrionette lines. Learn more.
COMING FROM AFAR: Dr. Shah sees a large amount of patients from all over the world. Using current technologies, such as video chat, Skype, and email, Dr. Shah makes traveling from afar a less daunting task. Begin the process.
|INNOVATIONS: Dr. Shah has had or contributed to a number of innovations and discoveries in facial plastic surgery. Learn more.|
FREQUENTLY ASKED QUESTIONS:
Am I able to wear makeup to hide the redness a week after the Medical Roll CIT procedure?
You are able to wear makeup after one week once you have healed.
What potential complications or side effects should I expect from the Medical Roll CIT procedure?
Overall the Medical Roll CIT procedure is very safe. However, realistic side effects that you may expect are prolonged swelling and redness.