ACNE SCAR TREATMENT
Acne scarring is one of the most common procedure we perform at London Lip Clinic. Most patients who come to see us with acne will have multiple scar types. These acne scars including box car scars, ice pick scars, and rolling scars. Each subtype of acne scarring will have an optimal treatment. Not all scars respond to one treatment. Some acne scars such as ice pick scars respond nicely to TCA Cross, whilst scars such as rolling acne scars respond to micro needling. An individually based method of acne scar treatments will give the best overall outcome. At London Lip Clinic every patient is assessed for the scar type, their skin type and downtime that is needed. Most patients will have mixed scars, namely rolling scars, box scars, ice-pick and anchored scars. This means that multiple modalities are required. We will formulate a treatment plan over a period of 4-8 months to achieve the best and desired result.
Patients must have realistic expectations. In some patients suffering with acne scars 90-95% improvement is possible, however in difficult cases, only 30% improvement can be met. A lot of patients we see have tried different treatments elsewhere before. This may be at their GP, beauty therapist or other clinics. Acne scar treatment is like having dental work done. You will require many visits and you have to be committed and patient to see the results. We employ many techniques to see how your scars responds. At the end of the treatment, individual scars can be targeted to get the best outcomes. The aim of our treatment is to improve the acne scar.
Acne scars, no matter how old or severe can be improved. Two factors determine the ideal type of treatment- skin type & acne acne scar type. Each patient will receive a minimum percentage of improvement with an individually prescribed program
Techniques used at our clinic involve minimum down time such as TCA Cross, chemical peels, Micro needling and dermal fillers to treat your scars. Each type of scar will be given an optimal treatment. Matching scar types and skin types to acne scar treatment procedures is the key to success. On average, 70-80% of acne scars can be improved with our prescribed skincare and treatment programme. Each program can take between 2-14 months to complete, depending on the severity of acne scars and your skin type.
ACNE SCARRING & MICRO NEEDLING
Dermapen micro-needling is an advanced nonsurgical cosmetic procedure used to treat a wide variety of skin concerns including reducing the appearance of wrinkles, smokers’ lines, large pores, acne and burn scars. It can also be used for regulating skin pigmentation and treating sun damage.
It is thought that needles break collagen bundles in the superficial layer of the dermis that are responsible for scars with subsequent induction of more collagen immediately under the epidermis. It is currently used in the cosmetic art to treat several skin conditions, such as pigmentary disorders, wrinkles, post-acne atrophic scars, burn-related scars, and big pores and is also a part of percutaneous collagen induction (PCI) therapy.
ACNE SCAR & SKIN PEELS
ACNE SCARRING & TCA CROSS
TCA CROSS is the chemical reconstruction of skin scars (CROSS) using trichloroacetic acid (TCA). It is most often used as an outpatient clinic procedure to treat atrophic acne scars. It’s safe and efficient, but is not always effective.
The TCA CROSS procedure involves depositing small amounts of TCA at high concentration (70–100%) onto the surface of the atrophic scar. This causes a local inflammatory reaction leading to the formation of new collagen fibres. The aim is to improve the appearance of the scar by increasing collagen reflectance and reducing shadows cast over scar depressions. Complete resolution is unlikely to be achieved with this treatment method alone.
We perform this procedure for the treatment of enlarged pores, and deep ice-pick acne scars. TCA CROSS can also treat other forms of scarring including linear scars as well as shallow box-car scars. This treatment can be used on all skin types including ethnic and Asian skin. 2-4 treatments spaced 6-8 weeks apart are needed for optimal outcomes.
TCA breaks down the scar and denatures collagen, stimulating new collagen to ‘fill in’ the scar. The deep the scar the better it works. Collagen stimulation takes at least 3-4 weeks to form, and is maximal at 3-4 months, hence why we advise at least 6-8 weeks between TCA CROSS treatments.
TCA CROSS is useful in the following types of atrophic scar:
Boxcar acne scars
Pitted acne scar
Rolling acne scars
Ice-pick acne scars
BEFORE THE TCA CROSS ACNE SCARRING PROCEDURE
Please wear sunscreen every day, treatment may be cancelled if there is marked tanning or sunburn. Darker skin may benefit from using a bleaching cream nightly for 2 weeks before the procedure. If you have had cold sores, please tell me as preventive treatment may be required, starting the night before. A prescribed anaesthetic cream is sometimes used, please discuss with me. If so, apply to clean, dry skin every 15 minutes, starting 2 hours beforehand and extending 1cm outside the area to be treated.
DURING THE TCA CROSS ACNE SCARRING PROCEDURE
TCA CROSS is technically straightforward to perform and can be undertaken in a matter of minutes, depending on the number of scars to be treated. It is generally repeated on several occasions at 2 to 4-week intervals.
The patient should be in a comfortable semi-recumbent position and remain still during the procedure. The skin is cleansed with chlorhexidine/saline-soaked gauze. A fine blunt end-point instrument (such as a tooth-pick) is dipped into TCA and the excess is removed. TCA is focally applied to the base of the atrophic scar. The instrument is removed at the start of frosting of the skin surface (usually within 10 seconds). The procedure is repeated for appropriate remaining scars. The skin is intermittently cleansed using saline/chlorhexidine soaked gauze. Antibiotic ointment or Vaseline is applied.
The sequence of healing after TCA cross is:
- frosting which last 30 minutes.
- redness which lasts 1 or 2 days
- scabs which last 3 to 7 days
- redness after the scabs separate which lasts 7 to 28 days
- final healing
AFTER TCA CROSS ACNE SCARRING PROCEDURE
The patient should be advised:
Frosting of the scar surface will last up to 12 hours
The skin around the treated sites will be red and sore for 24 to 48 hours
After 2 to 3 days a small scab will develop, which falls off after 3 to 7 days
He or she may wash as normal and may apply make-up if desired
Sunscreen is recommended to reduce the chance of pigmentation.
Most patients require 3 to 6 treatments with TCA CROSS for optimum improvement. Treatments may be repeated at 2 to 8 week intervals over 6 months.
The white frost lasts up to 12 hours and is followed by 1-2 days of redness and soreness. After 2-3 days, a small scab develops and should be allowed to fall off by itself after 3-7 days WITHOUT PICKING. Subsequent redness takes up to a few weeks to settle. Darker skin often develops brown discolouration which may take several weeks to months to resolve and is treated with sun avoidance, sunblock and bleaching cream.
Cleanse your skin 2 x daily (Aveeno or any other cleanser ), gently pat dry and apply antibiotic ointment or Vaseline until the scabs come off. After this, sunscreen must be applied daily throughout the course of treatment and for 3 months afterwards to prevent pigmentation. Darker skin should have bleaching cream applied nightly.
Treatments are repeated every 4-8 weeks. Usually, 2-3 treatments are needed but 1-2 extra treatments are needed in darker skin as lower strength TCA is used. Improvement is a gradual process due to the body’s formation of collagen over the three months following the last treatment.
Complications of TCA CROSS
TCA CROSS is generally well tolerated. Complications are rare when treatment is undertaken by an expert. They may include:
Prolonged local irritation and erythema
Damage to mucosal surfaces, ie lip, nostril, conjunctiva or cornea (eye) leading to painful ulceration and potential scarring, if TCA is inadvertently deposited on these sites
Post-inflammatory hyperpigmentation (usually transient) or hypopigmentation (this may be permanent)
Coalescence of adjacent scars to form larger scars
Sub-optimal response or lack of improvement in scarring.
ACNE SCAR & DERMAL FILLERS
Dermal filler treatment is an excellent choice for atrophic and depressed acne scars. The advantage of fillers in treating acne scar treatments is that results are instant with downtime zero. Patients can require anything from 1 to 4 treatments for best results. The improvements can be anything from 50 to 100%. It all depends on the acne scar type, location and skin type, depth of the scar and whether depressed scars are tethered to underlying structures.
During the process of filling the acne scar with dermal filler, i usually first start with subcision. This helps free the scar from fibres/bonds that hold the scars and also stimulates the new collagen induction process. I usually use hyaluronic based dermal fillers with itself stimulate collagen. The final results are instant and long lasting.
To minimise pain during treatment, we advise you to arrive thirty minutes in advance of your procedure so that we can apply an anaesthetic cream. To prevent bruising: try to avoid consuming alcohol 48 hours in advance of your treatment. Do not administer any blood-thinning medication five days before your treatment, such as Naproxen, Ibuprofen or Nurofen – if necessary consult your doctor on this. Our advice is also to quit any food supplements, vitamins or fish oil five days in advance of your treatment and to start taking Arnica drops around the same time.
During the dermal filler acne scarring treatment:
After determining which scars will be treated, we will clean the affected skin area with alcohol before injecting a very fine needle into the area with the chosen dermal filler. A popular range of fillers from Allergan including the VYCROSS range are longer-lasting fillers. Juvederm dermal fillers are based on formulation of hyaluronic acid. This substance occurs naturally in the skin, where its role is to retain water for moisture and plumpness. Injected into the skin, hyaluronic acid fillers can be used to smooth out imperfections.
After the dermal filler acne scarring treatment:
Stay out of the sun (and the tanning salon) for the first week after treatment. We do not recommend visiting the sauna, jacuzzi, massage etc in this period either. We would like to welcome you back for the check-up appointment to go over the results after three weeks.