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Acne Scars
Acne scars has always been a problem that many sought to solve, however, It is rarely possible to completely remove acne scars and, as a result of misleading publicity, the majority of the population has unrealistic expectations of the available treatments. So, What is the best treatment for acne scars?
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If abrasive and ablative therapies are performed to the depth necessary to remove the base of a deep acne scar, the entire surface of the skin would be left scarred and hypopigmented. This is barely a wanted result from treating an acne scar.
Realistically, 30% to 50% improvement in acne scars are usually the best that can be achieved.
Acne scars consist usually of the depressed type though keloid scarring, is common on the upper trunk. The scarring can be divided into different morphologic types, namely:
* Distensible acne scarring - a softer pattern of scarring that resembles a copper-beaten appearance and seems to disappear if the skin is placed on stretch
* Pitted acne scarring - sharply defined small pits with vertical walls
* Ice pick - sharply defined acne scarring that penetrates deeply into the skin
* Subcutaneous damage - the postacne damage from the acne scars may also affect the subcutaneous fat inducing loss of tissue volume.
What is the best treatment of acne scars?
We will now discuss the various treatments of acne scars and discuss how each of them are unique:
Distensible scarring
Filler substance injection
Injection under each acne scar can be very effective in correcting depressions. The newer hyaluronic acid gels have good persistence and once an adequate correction has been achieved the procedure may only need to be repeated annually.
*Resurfacing
Ablative resurfacing achieved mechanically with deep dermabrasion or using ablative laser such as pulsed/scanned CO2 or erbium can produce some degree of improvement in acne scars. The treatment is applied to entire facial units, not just to the scarring. The effect is probably more related to skin tightening effects than contour remodelling. This form of treatment carries a significant risk of hypopigmentation and scarring, requiring serious consideration prior to treatment. The so-called 'microdermabrasion' performed by beauticians does not penetrate into the dermis and has no proven long-term effect on scarring. Nonablative resurfacing using lasers that spare the epidermis but produce injury to the dermis is claimed by some to be of benefit, but the true effectiveness remains as yet unproven.
*Pitted and ice pick scarring
The main treatment is tissue removal by excision and suture, punch excision and grafting, or the punch elevation (float) technique. This introduces the possibility of new scarring and requires serious consideration prior to treatment. Occasionally some lesions respond to subcision. This involves using a hypodermic needle to undercut a scar via a single puncture hole. It usually needs to be repeated.
Unfortunately filler substance injection is not effective as the filler material spreads beyond the scar and produces a doughnut effect.
*Underlying fat atrophy caused by acne scars
This is corrected using autologous injectable fat grafting.
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