Understanding Acne And Acne Scars: How Are They Formed?
Acne occurs when the dead skin cells and sebum, along with bacteria, accumulate in your skin pores, causing inflammation and lesions. Your body has a mechanism to fix this damage. It repairs the damage by forming more collagen. This ends up changing your skin texture by forming indentations or raised areas (hypertrophic or keloidal scars) on your skin (due to the excess collagen formation), resulting in a scar. In other words, you can get acne scars when your skin starts to heal. Depending on how much excess collagen your skin has formed or lost, acne scars can be classified into three types:
Atrophic Scars
These types of scars are formed when there is tissue loss during the acne recovery process. This causes depression in your skin. Icepick scars (deep scars), rolling scars (usually M-shaped), and boxcar scars (U-shaped scars with a wide base) are the three types of commonly seen atrophic scars (1).
Hypertrophic and Keloidal Scars
You get these types of scars when your skin forms too much collagen, causing bumps and ridge-like areas on the surface. There are bundles of collagen within the area where there is acne. Hypertrophic scars are raised scars that occur on the site of injury (or acne). These are thick and wide and usually, occur during the healing process. On the other hand, keloids appear as red-purple papules that can spread beyond the acne-affected area. Both hypertrophic and keloidal scars are common in dark-skinned individuals and mostly appear on the trunk (1).
Laser Treatment For Acne: How Does It Work?
Lasers are intense monochromatic lights that are limited within a narrow band of wavelengths. These monochromatic lights are used on your skin to stimulate the dermal fibroblasts (cells in your skin that can form connective tissues and facilitate wound healing). These fibroblasts remodel the collagen and elastin that were lost due to scarring (2). Usually, ablative and non-ablative lasers are used for acne scar treatment. You can find out more in the next section.
Types Of Laser Treatment For Acne Scar Removal
Lasers that are used for acne scar removal mainly fall into two categories:
Ablative Lasers: These lasers can improve acne scars effectively and offer impressive results. They remove the damaged tissue by vaporization or melting it. The most commonly used ablative lasers are Erbium YAG and Carbon dioxide (CO2) lasers. These erode the scar surface and tighten the collagen fibers under your skin. Ablative lasers have a longer recovery time (1). Non-Ablative Lasers: Non-ablative lasers have a shorter recovery time, but the results are less impressive as compared to ablative lasers. These lasers do not remove any tissue from your skin but boost collagen development and make your skin tight. The most common non-ablative lasers used for acne scar treatment are the diode and NdYAG lasers (1).
Here is a detailed overview of the types of laser treatments used for acne scar removal:
1. Intense Pulsed Light (IPL)
Intense Pulsed Light works on the principle of selective thermal damage in the target area. These devices emit polychromatic, noncoherent, high-intensity pulsed light that has a broad wavelength spectrum. This combination of wavelengths, pulse durations, and pulse intervals assists in treating a wide range of skin conditions (3). Intense Pulsed Light (IPL) is widely used for treating rosacea, telangiectasias, sun damage, and pigmentation (face, hands, and chest) (3). A study published in the Osong Public Health and Research Perspectives found that IPL was very effective in treating hypertrophic scars and keloids. The study compared both cryotherapy and IPL for acne scar treatment. Both showed promising results in treating acne scars, but IPL had lesser complications (4).
2. Fractional Laser Treatment For Acne Scars
Fractional CO2 laser resurfacing uses a variety of microbeam sizes and densities to suit the needs of the patient. The fractional CO2 system can be used easily on other parts of the body (other than the face). This treatment can help eliminate existing acne scars and also prevent new scar formation (5). It is mainly used for treating sun damage, wrinkles and fine lines, pigmentation, and photoaging-related issues.
3. Erbium: Yttrium Aluminum Garnet (Er: YAG) Treatment For Acne Scars
This treatment method uses infrared rays of wavelength 2940 nm that penetrate the skin, causing tissue ablation (removal). However, compared to the other types of laser therapy, the tissue vaporization and desiccation (extreme drying of tissues) is lesser in this process. The collagen in your skin absorbs the laser and supports the healing and regeneration process within the skin layers (6).
4. V-Beam Laser or Pulsed Dye Laser (PDL)
Pulsed Dye Laser (PDL) is the go-to for improving scar-associated erythema. In a study conducted at the Seoul National University College of Medicine, 20 patients with acne erythema were treated with PDL (two sessions of 595 nm laser), and it was found that 90% of the patients experienced clinical improvement in their condition (7). Another small study found that PDL also improved the depressed appearance of acne scars. It was also found to be effective in enhancing atrophic, icepick, and deep boxcar scars. PDL should be used cautiously on people with dark skin as its blistering can lead to post-inflammatory hyperpigmentation or hypopigmentation (2).
5. Smoothbeam Laser Treatment For Acne Scarring
This process involves using a low-energy 1450 nm-diode (non-ablative) laser for treating acne scarring. It uses a dynamic cooling device that deep cools the target area of your skin using short blasts of cryogen spray. This protects the topmost layer of your skin, the epidermis. This is quickly followed by another laser beam that targets the upper dermis. The heat generated from the second laser boosts collagen development in the deeper layers of your skin, improving the appearance of acne scars. According to a study, treatment involving Smoothbeam laser and 30% trichloroacetic acid peels can cause a noticeable improvement in post-acne scarring (8). However, another study concluded that this treatment method needs to be refined and standardized further to minimize side effects. This study involved 30 subjects who had post-acne scars. They were treated for 18 months (including follow-up sessions until six months post-treatment). Only 53.3% of the cases showed satisfactory results, and about 66.7% experienced post-inflammatory hyperpigmentation (9).
6. PRP And Microneedling For Acne Scars
During a session of microneedling, the dermatologist uses a special device to prick your skin to boost collagen development. That is why microneedling is also known as Collagen Induction Therapy. The results of microneedling therapy depend on its depth. A depth of 2 mm is needed to see any visible improvements. However, this can be painful. Sometimes, during the session, the dermatologist may also use PRP or platelet-rich plasma injections. This, of course, involves an additional cost. When combined, both the procedures were effective in treating rolling and boxcar scars. However, they were not very effective on ice pick scars. A study involving 30 patients found that about 23 of them experienced an improvement in scarring by one or two grades, while 5 experienced excellent results (10). In another study involving 37 patients, researchers found that 36 patients showed remarkable improvement in atrophic scarring after undergoing microneedling (11).
7. eMatrix Sublative Rejuvenation For Acne Scars
This procedure gently resurfaces your skin and improves the skin texture by reducing acne scarring and wrinkles. This process uses radiofrequency (or electrical pulses) to smoothen your skin. Each pulse delivered to the skin activates the fibroblasts in the target area, which then signal collagen regeneration in the area. The untreated tissues in the adjoining parts support the healing process.
8. Profractional Laser Treatment for Acne Scars
This laser is an Erbium: YAG laser that treats fractions of your skin by creating numerous microchannels within your skin tissues that boost collagen development and smoothen acne scars. The laser not only improves the scars but also tightens the skin, minimizes wrinkles, improves texture, and reduces photodamage. Laser resurfacing treatments are non-invasive and usually ensure positive results. However, there are risks involved in these treatments. Before considering undergoing laser treatment, you need to be aware of its pros and cons.
Laser Resurfacing Treatments For Acne: Benefits And Risks
Benefits
Laser treatments allow for treating a targeted area on your face. They are very effective. You can see a dramatic change in your skin texture and get long-lasting results, depending on the choice of treatment. They are better than undergoing surgeries and other skin procedures. Compared to surgery, laser therapy involves lesser tissue damage and has a shorter recovery time.
Risks And Possible Side Effects
Usually, ablative lasers have some complications and side effects, including short-term effects like fungal and bacterial infections, and long-term effects like hyperpigmentation and persistent erythema. Overtreatment of a particular area with CO2 laser therapy can cause scarring. Overtreatment of any area might also cause infection. However, improper after-care is also a major reason for infections. That is why patients should be cautious about their post-treatment skincare regimen. You may also experience swelling, redness, discoloration, crusting, and pain in the treated area. If you notice any of these side effects, consult your doctor immediately. Your skin will look irritated and red during the recovery time. Though the laser does not burn or peel your skin, the exposed new layers of your skin will remain sensitive to the environment and chemical or natural elements. For those with a darker skin tone, the skin might appear discolored (lighter or darker than your normal skin tone). You need to adhere to the dermatologist’s guidelines to limit your pain and facilitate the recovery process. The availability of treatment is an issue. Also, it is pretty difficult to find a skin rejuvenation center that offers a wide range of laser treatment services (depending on the location).
There are certain things you need to consider before jumping on the laser treatment bandwagon.
Things To Consider Before Going For Laser Treatment For Acne Scars
1. The Cost Of The Procedure
It is expensive. Although the cost varies from place to place, it can be anywhere between $200 to $3,400, depending on the scars and duration of treatment or number of sessions.
2. It Does Not Get Rid Of The Scars
Surprised? Apparently, it looks like your scars are gone for good. But the truth is, the laser treatment does not make them vanish entirely. Instead, it makes them less noticeable.
3. The Outcomes Depend On The Skills Of The Person Performing The Procedure
If the person performing the laser treatment is not skilled enough, you may not get the desired results. Hence, before booking an appointment, ensure that a certified dermatologist is performing the procedure. The treatment outcome also depends on your body’s ability to make collagen and how diligent you are in following the post-treatment skincare routine.
4. Always Go For A Consultation
This is because the dermatologist who will be performing the treatment must consider your skin type, your health, and the condition of your scars. They also need to know your medical history and/or any supplements and medications you are on.
5. The Treatment of May Involve Multiple Treatments
Sometimes, for best results, the dermatologist may combine two or more treatments for scar reduction. For instance, the dermatologists may use a laser for scar treatment and also suggest using fillers. Also, you may require more than one session.
6. Results May Take Time
It can be weeks or months before you see any actual results on your skin. It depends on your skin and the degree of scars you have. If you have made up your mind to go for laser treatment for acne scars, you need to prepare beforehand for that. Here’s what you need to do.
Preparing For Laser Skin Resurfacing For Acne Scars
1. Limit Your Sun Exposure
This is applicable both before and after the treatment. The dermatologist cannot perform laser treatment if you have a tan as it might cause serious discoloration. After laser treatment, you need to limit your sun exposure to prevent further issues, such as hyperpigmentation or hypopigmentation.
2. Lifestyle Changes
For best results, you may need to make a few changes to your lifestyle, such as:
Quit smoking before the treatment. You may have to discontinue a few medications and supplements (otherwise, they might delay the healing process). Stop using skincare products containing glycolic acid and retinoids at least 2-4 weeks before treatment. Avoid using any medication that may cause photosensitivity. Avoid tanning. If you have a history of herpes in the treatment area, inform your doctor because you may need to take certain medications before the procedure.
After the procedure, recovery may take time. Here are a few things that you can expect during the recovery phase.
What To Expect After Undergoing Laser Resurfacing Treatment For Acne Scars
You may experience swelling, which is normal. Your doctor may prescribe medication to reduce swelling. Keep the treated area clean. You need to clean it several times a day and apply ointments for wound care. Your doctor will guide you in this regard and also prescribe medications. You may feel an itching or stinging sensation in the treated area. It may continue for 12-72 hours after the procedure. Your skin may even peel and become dry. Healing usually takes 10-21 days, depending on the type of treatment, the area of treatment, and the way it heals. Once it heals completely, you can get back to your usual skincare or makeup routine.
You need to stay in touch with your doctor during the healing phase. If you notice any changes in your skin, talk to the doctor. Consult your dermatologist beforehand to determine whether you are eligible for laser resurfacing treatment or not. Undoubtedly, this is the fastest way to deal with acne scarring. However, you should also be aware of the complications it may cause. Evaluate all aspects of the procedure before you decide to go through with it. Who is eligible for laser resurfacing treatment? While laser treatment cannot remove acne scars completely, it can significantly reduce the visibility of deep or hyperpigmented scars and the discomfort associated with elevated scars. If acne scars have made you feel self-conscious about your looks, laser treatment could be a simple and effective way to reduce their visibility and boost your self-esteem. People who have acne scars (or any other type of scar), wrinkles, pigmentation, age spots, and superficial acne are eligible for the treatment. Can acne recur even after undergoing laser treatment? Are the results permanent? It depends on how well you follow the post-treatment guidelines. You need to work with your dermatologist and devise a lifestyle plan to prevent acne. Moreover, people with mild acne may get different results as compared to people with severe scarring. What is the recovery time for laser treatment? It depends on the type of laser treatment you are undergoing and the kind of scars you have. Recovery may vary from a few days to weeks. For instance, for those with mild scars, the recovery time maybe a few days, while for those with severe scars, it can take weeks. Is laser treatment painful? It may hurt or may not hurt (depends on factors, such as the area and depth of treatment and the patient’s ability to bear pain).
