Laser treatment for acne scars is not possible unless previous subcision is carried out.
This is where an instrument is inserted beneath the skin to cut through old fibrotic collagen that is tethering the skin to deeper layers of fascia & fat.
The scars are usually sunken and are called variously as ice pick, box scars or rolling according to their shape.
This subcision, can itself provoke further scarring especially in dark skins.
In addition, laser treatment for acne scars entails carrying out a focussed controlled thermal injury to the scar to remove the surface cells .
Heat itself, has two other effects:
1. It burns the blood vessels and, as blood is essential for healing, there is a risk of replacing one scar with another one.
2. A laser burn injury has another much more dangerous risk. It provokes a hyperpigmentation reaction which can be very resistant to treatment. This risk of developing dark patches is much greater in people with dark skins.
Therefore, laser treatment for acne scars cannot be a “stand alone” treatment .
It can only be used in conjunction with surgical subcision.
This is where micro needling is a much more effective treatment . Here a device called Dermarollex, which is a cylinder mounted with 192-540 needles is rolled over anaesthetized skin.
The needles enter the skin and carry out the subcision, but do not reduce the blood supply to skin.
On the contrary, the bleeding which ensues this procedure activates platelet-borne growth factor that stimulates new collagen to be formed and fill the loose space, after release of the adherent fibrotic scar collagen.
The more superficial acne scars can be resurfaced very effectively using a compound (contains multiple ingredients) chemical peel which must contain :
a) Fruit acid i.e. Glycolic acid (to dissolve the skin protein).
b) Azelaic acid (to prevent any new acne spots & also address any hyperpigmentation).
c) Phytic acid (which is a powerful anti-oxidant & anti melanin ingredient).
d) Salicylic acid (which is an intensely bactericidal & anti inflammatory agent).
Acnex peeling mask is such a product that carries out safe resurfacing without the risks associated with laser acne treatment.
Regardless of which method of skin resurfacing is used, for a good outcome, a controlled micro injury is necessary and therefore a suitable topical application must:
1) Control inflammation
2) Limit proliferation
3) Speed up maturation
1)Sealing & Hydration:
Silicones e.g. dimethicone & cyclopentasiloxane.
These are inert sealers and very effective in controlling scarring.
Hyaluronic acid works by attaching 1000 molecules of water to each molecule of it. This creates an atmosphere of high moisture that stops the collagen production.
These are essentially Vitamin C10 %, Vitamin A and antioxidants like Ferulic acid that give the best healing environment to skin cells.
3)Anti inflammatory agents:
Salicylic acid 2%,Rutin & Bromelain are very effective anti-inflammatory agents.
Unless the above ingredients are present in a topical post-resurfacing preparation, the results are not going to be optimum.
One preparation designed with the entire above ingredient is Scar Repairex Ultra, which is topically used and applied to healing tissue twice daily.