Acne Scarring

Before and after treatment for Acne scarring
Before and after treament at for acne scarring, with fractional laser, skinbooster and dermal fillers and qswitched laser

Enduring acne is unpleasant enough; you shouldn’t have to live with scarring, too. We specialise in treatments to minimize acne scarring at our Sydney cosmetic clinic, using a multi-modal approach to restore smooth, even skin. Our cosmetic doctors and therapists use different treatment techniques to address various types of acne scars.

What Causes Acne Scarring?

Acne scarring is the result of an abnormal wound healing response. Inflamed acne triggers the production of collagen to repair the skin but in some cases the collagen fibers aren’t as smooth or flawless as the original skin. Early and definitive acne treatments are vital to prevent scarring.

What Are the Different Types of Acne Scars?

There are 2 categories of acne scars, atrophic, and hypertrophic scarring. The classification of acne scarring guides the choice of appropriate treatment options. We can also identify acne scarring as mild, moderate, or severe.

Atrophic Scarring

Atrophic scars are the most common type of acne scarring. Destruction and loss of tissue, as well as atrophy in the superficial subcutaneous fat result in contraction and subsequent tethering down of the epidermis.

Atrophic scarring can be categorised into the following groups:

Ice Pick Scars

  • Less than 2mm wide, narrow, deep, sharply demarcated 
  • Can extend into deep dermis/subcutaneous tissue
  • Wider at epithelial surface and taper downwards
  • Resistant to most skin resurfacing options (due to their depth)

Rolling Scars

  • 4 to 5 mm wide, more shallow, undulating appearance
  • Rise and fall of skin surface due to fibrous anchoring of dermis to subcutis
  • Requires treatment at subdermal level

Boxcar Scars

  • Wider at the base, does not taper
  • Round to oval depressions in the skin with crisp margins
  • Can be shallow [less than 0.5mm deep] or deep [more than 0.5mm deep]

Hypertrophic Scarring

These raised scars gain collagen as the lesion heals. The result is a firm, raised papule or plaque. They develop within 4 to 8 weeks of injury with rapid growth for 6 months. They do not extend beyond the margins of the injury and are not progressive. In fact, the scars may regress after 12 to 18 months. Recurrence rates after revision are low.

Keloids are a different type of hypertrophic scar that are progressive and extends beyond the margins of the injury or lesion. Regression is unheard of. Keloids can develop up to several years after even a minor injury. They have a high recurrence rate after revision.

Red or Pigmented Scars

Hyperpigmentation or redness can highlight the appearance of both atrophic and hypertrophic scars. Addressing this aspect of acne scarring early can drastically affect the overall appearance of the scars.

What Are Treatment Options for Acne Scarring?

We offer a wide range of acne scar treatments at our Sydney clinic to address each individual’s unique condition. They include everything from laser treatments for the whole face to procedures that target specific scars.

Full Face Treatments

Full Field Laser Ablation Resurfacing

During a full field ablative resurfacing procedure, the skin’s entire surface is treated. This is different than what occurs using a fractionated laser, which creates pinpoint channels in the skin but leaves some tissue undamaged. We may use either Er:YAG (Erbium) or carbon dioxide (CO2) lasers. Ablative laser resurfacing is an effective option for acne scarring but typically requires between 5 days and 2 weeks of downtime, depending on the treatment’s depth. Some of the risks include persistent redness, post-inflammatory hyperpigmentation, and scarring.

Fractional Ablative Laser

Fractionated ablative laser is a successful treatment for acne scarring. Either Erbium or CO2 lasers are options using the fractionated mode. This option can achieve a greater depth than full-field resurfacing but only treats approximately 10% to 20% of the skin surface area compared to full-field resurfacing. Recovery is quicker most patients needing 3 to 4 days to heal. Optimal results will require multiple procedures.

Fractional Non-Ablative Laser

A fractionated non-ablative laser treatment involves 3 days or less of downtime but patients need many treatment sessions to reach the desired results.

Fractional RF or Microneedling RF (Radiofrequency)

Using radiofrequency energy, either with microneedling or fractional bipolar technology can provide significant improvement in the appearance of acne scars after 3 to 4 treatments. These procedures work by passing a current through the dermis which produces small thermal wounds. These, in turn, stimulate collagen production. Downtime is quite minimal.

TCA CROSS FOR ACNE SCARRING
TCA CROSS for acne scarring

Treatment on Individual Scars

Targeting acne scars that resist full-field treatments often requires multiple procedures so it’s beneficial to start with them.

Subcision

The idea is to cut the underlying tethering. Beveled (slanted) needles can be used depending on the scars to be treated. The doctor places the needle in the dermis with the bevel flat and then moves it through the scar in a fanning pattern. The needle is then rotated 90 degrees and the fan repeated. Pressure is applied after the procedure.

TCA Cross

This procedure covers the base of a scar with a very small amount of highly concentrated trichloracetic acid (TCA). A toothpick is most commonly used but other methods can also be used. The interior lining of the scar undergoes a chemical peeling process and new collagen forms in the scar, decreasing its depth and severity. A small scab develops and then falls off after 3 to 7 days. This treatment can be repeated at 4- to 8-week intervals. TCA Cross is the most effective treatment for safely treating deep acne scars. Patients tolerate the procedure quite well and they rarely require any form of anaesthesia. Sun protection is essential for the first week after treatment. 

Injectable Treatments for Acne Scarring

Dermal Fillers

Dermal Fillers are the preferred method for rolling scars. Patients can see results immediately, which they love. It’s important to use a filler that doesn’t absorb too much water and is moderately crosslinked. Belotero Balance and Teosyal RHA 1 or 2 are ideal. During placement, a modified subcision is performed to release underlying tethers. Minimal bruising and swelling settle promptly. Results have great longevity due to local increase in collagen production, secondary to both trauma and dermal filler.

Biostimulators

Certain fillers have biostimulatory effects, meaning that they stimulate the skin’s fibroblasts to produce more collagen, which is beneficial with acne scarring.

PRP

Platelet-rich plasma is rich with cytokines and growth factors, which work together to regenerate and stimulate the production of new collagen. The benefit with PRP is that it is autologous with minimal risk of allergy/ adverse outcomes.

Skinbooster treatment for acne scarring
Skinbooster sydney

Skinboosters

Skinboosters are very popular with patients with atrophic acne scarring. They can be used in the area of the scarring to make the skin appear more “plump” and more like the less scarred areas. The skin booster product also stimulated collagen in the area.

Skinbooster can be injected by hand or by using a beauty gun, where the depth can be set precisely.

Chemical Peels

We offer 3 levels of chemical peels to treat acne scarring:

  • Superficial: SCA/glycolic/lactic/Jessner (epidermal peel)
  • Medium depth: Jessner plus 10 to 25% TCA (to level of papillary dermis)
  • Deep: phenol containing (to level of reticular dermis); this is associated with some risk of cardiac toxicity/nerve damage

Dermabrasion

This treatment goes deeper than microdermabrasion with a high risk for postoperative scarring/pigmentary changes and milia formation

Skin Needling

During skin needling, the needling device (which has a cylinder with multiple microneedles on it) is rolled back and forth on the skin, causing multiple punctures in the skin.

Other Information

When creating a management plan for acne scarring treatments, we consider the following factors:

  • Acne status—active or resolved?
  • Wound healing—recent isotretinoin use?
  • Other skin conditions/risk of Koebnerization
  • Medications
  • Skin type and risk of pigmentary changes

Get in Touch

Our Paddington cosmetic clinic serves patients from the Eastern Suburbs to Bondi and throughout the Greater Sydney area. You can book online, or call us at (02) 9331 5005 to schedule your appointment.

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