Scar Revision for Acne
"Today, I wanted to talk a little bit about pitted scars, and pitted scars come in a couple of varieties. They are often from previous infectious diseases like chicken pox and now we're hearing about measles, but more commonly they're from acne.
We describe acne scars as being ice picked type of scars which are just like they're described, they're very pointed, very deep walled scars that are vertically oriented and has a central point to it. Pox scar type of scars where there's an almost a square edge to the scar, and there are other types too that you can get into that described them physically, but the bottom line on these scars is that they're depressed below the normal skin surface which creates shadows in the depth of these smaller scars and makes the skins look very irregular.
The traditional approaches to these have been some type of resurfacing including sanding or dermabration which is actually quite effective but we're not using those very often because they're messy and in today's world with the aerosolization of tissue there's some risks involve.
We more commonly use lasers for these things to bring down what we call the shoulder of the scar, the higher edges of these scars, that's an effective way of treating most acne scars, particularly if they're in a large area and there are many of them.
In cases where there are isolated scars, there are couple of options.
Subcision, a technique where you use a small needle and I’ve done this many times, and you undermined or break the little tether of the scar, can help to elevate that a little bit, but subsicion has variable results, it’s not very successful, I usually offer that as an option telling patients that we just don’t know. It's a smaller procedure by using a small needle to undermined or go underneath the scar and divide any of the bands or tethers that pull it down, we can sometimes get elevation.
When used in combination with a filler, it can be quite effective. In fact, one of the newer fillers called Belofill which is Poly(methyl methacrylate, is a permanent filler that creates collagen around this tiny little particles or microscopic beads of the Poly(methyl methacrylate that make up the filler.
It’s in a collagen-carrier, it’s been around for many years, but I’m not a fan of using it as a large scale volumizer in the lips or nasolabial folds but for isolated acne scars, this filler does offer a permanent solution to lifting or elevating a scar that might be depressed, especially something like an isolated acne scar or a chicken pox scar, which we still commonly see.
If one wanted to try something less permanent just to see if it help, subsicion and using an HA filler like Restylane, Perlane or Juvederm would be an excellent option, and you could see what the result would be although you'd know that it would be a permanent or long lasting result because these HA's do metabolize or go away overtime. Might last long's a year however so some people are interested in that, it is an option.
Finally, getting back to the surgical options. When we treat multiple areas of deeply depressed acne scars, often a punch excision of these small scars, and I use a tiny little punch biopsy tool, which takes out just the scar itself, and I’ll replace the punched out scar with some tissue that I can barrow from behind the ear with a similar matching punch. I’ve done up to about 300 of those little tiny punches over time and then I’ll come back and resurface it, I’ll make sure the punch is lightly higher than the surrounding scar, and this is a great way of getting rid of depressed scars and getting a much more even overall surface to the skin.
It's combined with some type of resurfacing always, so it’s a two or three stage procedure when we do punch excision and grafting, that would include then a second stage of using laser of some other type of resurfacing. I primarily use laser now and then possibly even a third stage of laser that make sure we're getting the smoothest possible result that we can get for acne or punched out small scars.
So these are difficult to treat and they're very bothersome to a lot of people if they're isolated there quite easy but if you have a number of them around the face or the zone looks rough and irregular its quiet bothersome and something we can do a lot about.
If you have any questions about acne or a punched out scars, I’m very happy to take your questions, you can send them to me at DrMaas.com, our video blog. Send them with a picture or even a video, which is better, along with any questions you have about treatment. You can visit our website at MaasClinic.com, and as always, I'm very happy to answer questions about ways that you can stay looking your best. This is Dr. Corey Maas on "Looking Your Best." "