Louis M. DeJoseph, M.D.
Acne and the scarring that acne causes is a tough problem that we see in many patients here at Premier Image Cosmetic and Laser Surgery. The first step in treatment is to get the acne under control. In some cases we refer our patients to a dermatologist to get them on a specific care program for their skin.Hormones can play a role in the development of acne and when this is determined to be the cause, we can use hormone replacement for those patients. In other cases we may put patients on low dose antibiotics. We also carrypharmaceutical grade skin care products that are very effective in treating acne. The important thing is to shut down the active acne.
Once the acne is under control then we begin our treatment of the acne scarring. Scarring comes in many different forms and acne scarring is different than other types of scarring. Acne scars are bound down and depressed. They form as a result of the body’s healing process but form with too much collagen in a particular spot. The original acne wound occurred within the dermis which causes the scar to be within the skin, rather than on the surface. This is why it is so difficult to improve.If the scarring is light with angular, well-defined edges and these are referred to as boxcar type of scarring. Then the very severe type of scarring is called ice pick scarring. It looks as though someone has poked holes in the skin. This is one of the most difficult things we face as plastic surgeons in trying to improve someone’s skin that has this type of scarring.
Traditionally the treatment of choice was dermabrasion where the outer layer of the skin is roughed up with a rotating tool. When the skin healed, smoother skin appeared. It wasn’t the most pleasant procedure and involved a lot of bleeding and a large amount of recovery time was required.
Today, we have fractional CO2 laser resurfacing. In this procedure, little tiny, microscopic holes are drilled into the skin which goes deep into the skin. This procedure puts deep heating into the skin, through the acne scars. When the skin heals it contracts leaving the scars dramatically improved.