Ask Dr. Barber

Q.  I have acne scarring on my cheeks and a few scars on my forehead.  My acne has gone away but I wish I could have smoother skin.  What is available that can help improve my skin?  I am in my mid 20’s and am otherwise very healthy.
A.  There are several options for improving facial scarring due to acne.  The correct choice of treatment that is right for you will be determined based on the depth of the scars, the age of the scars, and the number of scars that are present.  The deeper the scars and the more scars that are present, the more aggressive the treatment will need to be.  Typically, I will first recommend a skin care program before initiating any treatment.  The skin care program includes the use of tretinoin (Retin-A®) to stimulate new collagen, a skin bleacher to reduce any existing areas of hyperpigmentation on the face, and also to minimize the chance of developing new areas of hyperpigmentation following treatment of the scars.  Alpha-hydroxy acids are also used with the skin care program to help with exfoliation of the outer layer of dead skin.  The skin is typically pre-treated with this program for 3 to 6 months.  The results of this pre-treatment will help determine the next step.  There are a couple of options designed to stimulate additional collagen in the skin and resurface/smooth the skin.  A relatively new collagen stimulating treatment that we offer is micro needling or Rejuvepen®, a treatment that uses tiny needles that vibrate into the superficial dermis of the skin, penetrating the dermis and creating a very small controlled injury to the skin.  This micro injury stimulates collagen which will smooth the skin and can help reduce the depth of superficial scars.  This treatment is best for more superficial scars.  If your scars are deeper or cover a large area of the face, then another option is to perform laser resurfacing with a fractionated CO2 laser.  Laser resurfacing is more aggressive than micro needling and is reserved for deeper scarring.  This procedure can be performed with no sedation, under light sedation, or for badly scarred skin, under general anesthesia.  It often requires multiple treatments (3-4), spaced out about 6 months apart.  The laser uses light energy to create a controlled injury to the skin, which stimulates the skin to make new collagen.  The new collagen fills in the scars and reduces the depth, therefore making them less noticeable.  Recovery after laser resurfacing of the face is about 7-10 days, during which time there is swelling and redness of the face, but not very much pain.
It is important to know that no treatment will ever restore acne scarred skin to look like it has never had scars.  The goal is to improve the surface of the skin as much as possible, but perfection is typically not achievable.  Because laser resurfacing is a more aggressive treatment, designed to treat deeper scars, there is a rare chance of creating scars due to the laser itself.  Laser treatments should be performed by someone who is experienced with its use in order to minimize complications and maximize desired results.

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