Acne scars take on different appearances and fall into three categories: Atrophic: shallow and heal underneath the top layer of the skin, leaving a depression in the skin with collapsed and condensed collagen. The sub-classifications of those are as follows:
- Ice Pick Scars – deep, narrow, pitted scars that look like holes
- Rolling Scars – sloping edges making the skin look wavy and uneven
- Boxcar Scars – larger than ice pick scars with sharp, defined edges, looks like craters Atrophic superficial – ivory, flat, tiny wrinkle appearance (like a 1-2mm stretchmark).
Hypertrophic and Keloid
Scars are raised versions of the healed skin with white, pink, or dusky coloration. They are thick and wide with a waxy feel on the surface. High-risk areas include the jawline, back of the neck, center chest, shoulders. Hypertrophic scars stabilize at the original pimple’s site, remaining raised and can be tender or itchy. Keloid scars begin to spread with newly made bundles of tightly wound collagen beyond the origins and can be tender or itchy. Both have an overproduction of collagen, the mechanism and triggers not known. The gold standard of treatment remains Kenalog (steroid) injections to break down excess collagen, producing a softer, flatter, less symptomatic scars. Injections are generally done by medical health care provided in series over time.
Post-Inflammatory Hyperpigmentation
Known in short form as PIH, this is not a scar but is a discoloured spot or area resulting from the acne itself or from squeezing and picking. The healing process blurs the top layer from the skin’s underlying layer, and pigmentation becomes trapped among collagen fibres. Older blood vessels remain at the site of healing, giving a darker appearance.
Don’t Forget! Your dermatologist is also trained as a Dermatosurgeon! One of the only medical specialties to require this for royal college board certification!!
Dr. Fisher and Dr. Poulos and the dermatologists at Kingsway Dermatology & Cosmetic Centre have combined 20-25 years, each providing medical, surgical and cosmetic care for acne and acne scarring. Wow! Now that’s expert service.
BEST ACNE TREATMENT FOR MATURE SKIN
A combination of the best acne treatments for mature skin may be required for patients that have more than one type of scar. They assist in several types of scarring. PIH can be improved with laser genesis, chemical peels, and micro-needling. Fractionated ablative laser, micro-needling, subcision, and filler injections can improve ice-pick and boxcar scars’ appearance.
Stage 1 acne treatment for mature skin may include:
TCA Cross
This is droplets of trichloroacetic acid applied in a high concentration directly into the appropriate scars to cause an inflammatory reaction leading to new collagen formation to fill the deep pit. The purpose is to improve by filling scars created by acne to reduce reflection and shadows, minimizing the scar’s look and providing the appearance of smooth skin. This is not a rapid results treatment, so patients must manage their expectations with a range of 6 months to a year.
Punch Excision
This technique for revising acne scars on mature skin is reserved for isolated ice pick and minimal boxcar scars. It’s performed with a tool used for punch biopsies and is like a hole punch for your skin. It effectively excises firm, trapped scar tissue, and the sutured edges are sutured to close it up and heal, leaving a small even hairline scar. Both TCA Cross and Punch excisions must be followed up with another treatment modality. They’re considered Stage 1 treatments and must be followed with a Stage 2 treatment such as laser resurfacing and micro-needling.
Stage 2 acne treatment for mature skin may include:
Subcision
Subcutaneous incisional surgery is a perfect treatment for rolling scars. It works by using a hypodermic instrument, such as a cannula or needle, inserted by way of a small puncture and used to break fibrotic bands tethered to the tissue underneath. By untethering these fibrotic bands, you create space that allows for new collagen structures and wound healing formation. This treatment works exceptionally well with hyaluronic acid fillers’ placement underneath where the tethered scar to act as a support bridge while new collagen forms.
Fractional Laser Resurfacing
This laser resurfacing treatment works by creating microscopic pixelated punctures representing the injury zone (1/100mm and smaller). One can expect up to 20% improvement per treatment with a minimum of 4-6 treatments or more for atrophic (indented or pitted) scars. Creating this dermal injury allows the benefits of wound healing to occur in the various layers of the skin. The treatment helps to remove PIH and smooth surface scars. With precautions, ideal for all skin types.
Full Field Laser Resurfacing
Treats the entire face by removing a top layer. A laser beam scans the treatment zone and with precision and removes the layer. This leading acne scar treatment for mature skin is ideal for fair skin types, and downtime associated with it is 2-3 weeks and erythema that can last for several months.
Photorejuvenation
We have various light and laser therapies that can be used on a range of skin types to assist with lifting stubborn PIH and residual redness. These are the least invasive laser and light therapies with little downtime but are only attracted to the pigmentation and will not assist with other acne scars. Depigmentation skincare assists by removing PIH or acting as a pre or post-treatment for laser resurfacing treatments. Z.O. medical skincare and Universkin boutique ingredients provide unique lightening opportunities that are well tolerated and non-invasive.
