One reads of many ads in the papers touting acne scar treatment. What really works?
It all depends on the depth and type of scars - I categorize them into:
1) depressed scars - icepick or saucer-shaped
2) keloidal - more common on anterior chest
3) hemosiderin stains - red discolourations
Below is a list of treatments currently on offer with a brief commentary:
Icepick scars - best treatment would be punch excision but this is realistic only if you have a few of them. If you have multiple densely packed icepick scars, then it would be impractical to do this treatment. Another option is subcision and filler - in theory, it is quite appealing but I've seen some cases where the patient ends up with a lump under the scar which is still apparent. Another negative point is the expense of the filler material (if it is temporary then you 'll have to fork out every year). If it is permanent, there are so many controversies about what these permanent foreign bodies under your skin can do to you. Another filler option is your own fat graft but you'll have to find a plastic surgeon who is expert at doing this because fat grafts do regress somewhat.
More affordable options would be needle-abrasion and chemical reconstruction of scars - these are very affordable treatments which give good results.
Saucer-shaped scars - many treatments abound. But over the years, I've concluded that needleabrasion (>1.5 mm needle length) & fractional CO2 laser work the best. Other lasers either don't work at all or require more sessions than frac CO2 laser to achieve the same result. Microdermabrasion can help only very, very shallow scars.
Keloidal scars - Tried and tested options include intralesional steroid injections (it works but can leave red discoloration) , silicone sheet plasters or silicone gel (totally painless but may not work on everyone). Some newer options include radiofrequency, laser or IPL to "soften up" the scar - does not give consistent results but worth a try if the tried and tested options don't yield results.
Hemosiderin stains - pulsed dye laser gives best results but expensive. Cheaper option - good old chemical peel but must be done in experienced hands otherwise can result in chemical burns.
Just a quick comment on some other treatments:
DERMABRASION - it is mechanical sanding of the skin. Not suitable for Asian skin as we tend to develop post- inflammatory pigmentation.
Q-switch NdYag laser (often advertised in CN beauty salon ads) - good for fine lines but doesn't work on scars. Don't waste your money.
The short message is
- prevention is better than cure. One should not wait until it scars before treating acne because a realistic expectation from acne scar treatment is averagely 50% improvement - there can never be 100% reversal of scarred to unscarred skin.
- choose your treatments wisely and budget accordingly (make sure you can afford the full course of treatments) because half-hearted treatments will not give you much results.
