Acne

Updated 20 July 2014

Acne scarring: what you can do

Bad acne can leave you with a face that has more craters than the moon. Thanks to modern technology though, you don’t have to be scarred for life!

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You’ve finally got rid of those embarrassing zits and have spent a bundle of cash in the process and what do you have to show for it? A face that has more craters than the moon. Thanks to modern technology though, you don’t have to be scarred for life!

Before launching into the many ways to treat scarring, there’s one sure method of preventing or limiting the extent of scarring. Treat acne itself early and effectively, for as long as necessary.

Read more: Symptoms of acne

It has been proven that the more severe your acne and the longer you wait before getting adequate therapy, the greater the possibility of scarring becomes. Up to 95% of acne patients have some type of scarring. One study found that if you have acne for three years and you don’t treat it properly, facial scarring will result.

Treatment is expensive, so before going under the knife, decide how big an issue your scars are. Sometimes they feel worse than they look. The psychological scarring caused by acne scars is often worse than the cosmetic scars themselves. If you feel you can’t leave the house without 20 layers of base on or a paper bag over your head, then for you, treatment might be the only way you can live a normal life.

Read more: what aggravates acne?

What causes acne scars?
Scars form where a tissue is injured. If you have acne, such injuries are caused by the body’s inflammatory response to all the gunk blocking up the sebaceous follicle.

The inflammatory response alerts your body’s “repair kit” which is made up of white blood cells and inflammatory molecules whose job it is to repair the tissue and combat infection.

But the repair team often does quite a messy job, leaving behind them fibrous scar tissue or eroded tissue.

People with moderate to severe acne also become deficient in the chemicals needed to repair infection injuries. This is because acne consumes most of the body’s supply of critical healing chemicals such as calcium, zinc and antioxidants.

The repair process of infections is inadequate and too little collagen and elastin are manufactured, resulting in a severe depression at the injury site.

Read more: Myths about acne

Types of scars
Any treatment will depend on the type and severity of your scarring. There are two main types of scars: depressed scars that are caused by a loss of tissue and raised thickened scars that are caused by increased tissue formation.

Raised scars
Scars that result from increased tissue formation are known as keloid or hypertrophic scars. They are caused by excessive production of collagen that forms piles of fibrous masses, resulting in firm, smooth and irregularly-shaped scars. Keloids are the worst kind of scars to treat and are often hereditary.

Scars caused by loss of tissue
These are the most common type of scars. They are depressions in the skin and look like chicken pox marks.

Ice-pick scars: The name sounds worse than the scar actually is. An ice-pick scar is usually small with jagged edges and steep sides. These scars may be hard or soft. The soft scars are easier to treat by stretching than the hard ones.

Depressed fibrotic scars: These are larger scars with sharp edges and steep sides. The bottom of the crater is hard.

Soft scars: Can be superficial or deep and have gently sloping edges that merge with your skin.

Atrophic macules: These scars are soft with a slightly wrinkled base and may be bluish in appearance at first and will then turn ivory white in colour later on.

Follicular macular atrophy: These scars normally appear on your body and not on your face and are small, white, soft scars that are slightly raised above the skin’s surface – almost like a latent zit that didn’t come out.

Treatment options
The internet will bombard you with thousands of miracle cures for acne scars, but if you are searching for a solution that won’t leave you looking like Michael Jackson, read the following options and then consult your dermatologist.

Laser treatment
Laser treatment is the way of the future in most surgery procedures, because it leaves the least scarring and you won’t look like burn victim afterwards. You should recover in three to five days.

Lasers recontour scar tissue and reduce the redness of skin around healed acne lesions. Carbon dioxide lasers are one of the most powerful treatments available because they produce the most heat. The heat energy penetrates deep into the skin to tighten the collagen fibres, which elevates the depressions to the level of the normal skin.

The Erbium: YAG laser is less potent, but works by emitting light through bursts of energy that are absorbed by water in the skin. This allows for precise sculpting of irregular scars.

Autologous fat transfer
If you don’t fancy the idea of your face feeling like a Star Wars set, you can opt for a treatment method that involves taking the fat from one part of your body and injecting it underneath your scars to plump them up to the normal skin’s level. It’s like liposuction and botox in one!

This method is only used for very deep and severe craters and you’ll have to have it repeated every six-to-18 months, because your body reabsorbs the fat.

Gross as it sounds, bovine (cow) fat can also be used.

Skin surgery
If you have deep ice-pick or pitting scarring a la Bryan Adams, it cannot be treated by lasers or fat transfer. “Punch” excisional surgery may help you.

During this procedure surgeons basically cut out the scar and stitch the resulting hole up so that it will heal properly and look like normal skin. Alternatively, a small skin graph (a patch of skin from another part of your body) will be placed over the wound. Both treatments are permanent.

Subcision is another surgical technique that involves the use of a blunt surgical probe that lifts up the skin and pulls it away from the depressed scar tissue underneath.

Dermabrasion
Dermabrasion is thought to be the most effective treatment for scars. It involves the “sanding” down your surface skin and scar contours with a high-speed rotating wire brush. During healing, a new layer of skin will replace the abraded skin, making the face look a lot smoother.

Sounds like some kind of Chinese torture? Don’t worry, you will be put under local anaesthetic and the procedure only needs to be performed once. You will be out of action for one to two weeks, but the results will be permanent. Remember, no pain, no gain.

Microdermabrasion
Instead of using the rather barbaric-sounding wire brush employed in the dermabrasion technique, this treatment makes use of aluminium oxide crystals that pass through a vacuum to remove the surface skin.

Only the skin cells at the surface are gently scraped away and new cell growth is stimulated, so this treatment has the added bonus of creating no additional wounds.

Although microdermabrasion does not sound very appetising, it’s often called the “lunchtime peel” because it is such a quick procedure and it leaves minimal redness.

This is not a very hectic procedure and it is best suited to people with very mild scarring. Because of the superficial nature of this method, multiple treatments will be necessary.

Treating keloids
Keloids are the most tricky scars to treat. Surgical removal is hardly ever used on keloids, because if one’s skin is prone to forming keloids, more might actually form in response to skin surgery.

The only other two options are to inject steroids into the skin around the keloid, or to apply topical retinoic acid directly onto the scar.

Sometimes though, the best treatment for keloids is nothing at all.

What are the risks?
The different treatments available for acne scars all sound very high-tech and safe, and most of them are. But certain people, including patients that have recently taken Accutane, have active cystic acne or those that have unrealistic expectations of how the treatment will dramatically transform their lives, are not good candidates for treatment.

Resurfacing techniques may cause short or long-term pigment problems. Your skin tone may be increased temporarily or decreased for a longer period.

More scarring, infection and persistent redness can also result from treatments.

Any substances injected under the skin may be incorrectly positioned and may also cause allergies.

Some of these side effects are temporary, but others can be permanent, it’s just a risk that you will have to take.

Stars with scars

Has all this talk of lasers, chemical peels and surgery freaked you out? There is another pain-free solution. Do nothing. Live with your scars. Many famous people have learned to do this. Think Kevin Bacon, Seal, Bryan Adams and Richard Burton.

Read more: Stars with scars

Scars can give one character, why do you think that the stars mentioned above never had their acne scars treated? It certainly wasn’t because they didn’t have the money!

Alicia Keys and Cameron Diaz also have bad acne scars, we just don’t see them thanks to the wonders of photoshop and professional make up artists.

Weigh up the pros and cons. One major con will be the expense of such treatments. Your medical aid might not pay, because facial surgery could be considered as cosmetic.

On the other hand, if your face is severely disfigured and you feel that your scars have ruined your confidence and your life, treatment may just be worth the huge financial outlay.

Read more:
Prescription meds for acne

 

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