Acne Scars Treatment in Chicago, IL

Before and After

Lips are the most sensual feature of the face. Patients seeking lip augmentation can be as young as in their twenties to much older patients. Younger patients are often seeking a more seductive look to their face and more volume.

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.

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THE SCIENCE of 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.

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Acne Scarring

Acne scarring can be devastating for many reasons. For younger individuals, being taunted by their peers or lowered self-esteem is a reality. For adults, the scarring may also affect self-esteem and, unfortunately, have a subliminal influence on hiring and promotion decisions as well as dating and social acceptance.

Prior to the advent of laser skin resurfacing, the main option that existed was dermabrasion. CO2 laser resurfacing has all but replaced dermabrasion because it is a much more predictable and safer procedure.

The mechanism of action of laser resurfacing is to destroy all the outer layers of skin. When the skin heals, it produces new collagen and the new skin is smoother, tighter and with less pigment and scars. The new skin is red at first, then pink, then heals back to normal.

The laser procedure can lighten the color of the facial skin but this actually makes the patient look younger since the sun damage is gone. Extreme color changes are very rare. Although laser resurfacing can be very dramatic it is important for acne scar patients to realize that severe scarring will require multiple treatments. Many patients are satisfied with a single treatment while others have repeat touch up laser treatments. The touch up treatments are generally much simpler and can frequently be performed under local anesthesia. Some people require multiple touch up appointments with progressively less area treated until in some cases we are treating single scars.

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.

What causes acne scars?

When the body has a vigorous response, almost inappropriately strong, to acne bacteria, this can lead to inflammation. Intense inflammation over time cause scarring. Some people are more prone to scarring than others. Some patients with intense inflammation can end up with significant disfiguring scars.

The types of acne scars

There are different kinds of acne scars: ice pick, atrophic, and hypertrophic. Ice pick scars are deep pitted scars with steep edges. Atrophic scars are pitted but have smooth borders and are not as deep. Hypertrophic scars, more common on the back and chest, are thick, lumpy scars that sit above the surface of the skin.

Just as there is more than one type of acne scar treatment, there is more than one type of acne scar.

1. Box Car Scar: The box car scars or boxcar scars can be treated with a variety of techniques including CrossTCA or Medical Roll-CIT
2. Icepick Scars: The icepick scars can be either deep or shallow pits.  The scars can be treated by direct excision, Cross TCA.
3. Rolling Scars: Rolling scars usually are tissues which appear normal but have undulations within the skin.  The can respond to Medical Roll-CIT or subcision with filler placement
4. Raised Scars: Raised scars can be a result of acne and occur on nose/chin and torso.  Larger scars may respond to intralesional steroid injection.
5. Large Pore: Large Pores are very difficult to treat but some modalities which can benefit this include intradermal botulinim toxin and facial resurfacing.

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

ACNE SCAR TREATMENTS

The term ‘acne scar’ does not describe most patient’s skin accurately. Rather than a series of raised lesions, most acne scars are depressions within the skin. It is not known why some patients are predisposed to these depressions in the skin while others do not but some research hints at a genetic component. Treating these “acne depressions” often involves using techniques used to stimulate the body’s collagen fill in the depressions and textural abnormalities. Procedures such as laser resurfacing stimulate the dermis to create more collagen. Specific treatments such as Cross TCA and Pinpoint irradiation use a focused treatment to the scar itself in an effort to create collagen. Other techniques such as undermining the depressed area with a needle and using a longer lasting filler can be helpful as well to improve textural appearance.

LASER RESURFACING

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.

PINPOINT IRRADIATION

Pinpoint irradiation is a novel approach to acne scars.  Traditionally, LASER resurfacing has focused on resurfacing the whole face, including the areas not affected by scarring.  Pinpoint irradiation works by discretely treating the acne scar with a single C02 LASER beam, sparing the surrounding tissues.  This discrete treatment allows for a faster recovery by keeping the skin intact.  In a way this technique is like targeted fractionated C02 treating only the acne scars and not random locations. The benefit of fractionated C02 is quicker recovery and less chance of adverse risks.

Combination of Resurfacing and Pinpoint Irradiation

Dr. Shah uses a combination of erbium, fractionated erbium, C02, and fractionated C02 to resurface the face. The benefit of combining modalities is that more than 1 effect is created. The focused treatment of pinpoint is enhanced by creating overall improved texture with a fractionated laser treatment to the surrounding area, making the scars themselves more difficult to distinguish.

Fractora

Fractora is a novel approach in that needles are placed deep into the dermis and treating the skin with a bottom up approach. The benefit is that the epidermis can be spared if desired leading to faster recovery. Fractora uses radiofrequency needles that will improve texture and appearance of scars.

Subcision

Subcision in of itself is the use of a needle to undermine the scar to improve its appearance. Blood from the needling as well as the mechanical trauma has been theorized to create collagen. In Dr. Shah’s experience, this technique WITHOUT FILLER is NOT effective. The benefit of subcision with filler is that a matrix or spacer of material is placed in the subcised area, using a specialized subcision needle. The space is then filled with a longer lasting filler product to raise the scar from a depressed area to a flatter appearance. Histological studies of fillers has demonstrated that fillers often are replaced in the body with collagen, making subcision and filler an excellent technique for some types of acne scars.

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.

DR. SHAH uses two modalities for mechanical stimulation of scars. The medical roll cit is used for acne scars that are deeper in nature and needle penetration can be as deep as 3 mm. When the needle has penetrated the scar itself can be broken up and improved in appearance. A mechanized needling device is also used where penetration can be done rapidly (adjusted to over 100 oscillations per second) at a depth of 2 mm to create another method of penetration of acne scars. Different scars will utilize different approaches and may benefit from either of these techniques.

Acne Scar Testimonial

Acne scars are a journey for most patients and our patient videos demonstrate what to expect with some of our treatments at various stages of recovery.

Recovery Time

The recovery time can vary from treatment to treatment and the level of intensity. Patients wanting more aggressive treatments may want to have stronger settings at the expense of longer downtimes and more skin abnormalities. Patients can fine tune their experience to maximize their results while achieving a level of recovery acceptable to their work and social schedule. As every patient heals at a different rate, patients should be cautious about exact recuperation times.