Extremely common, acne can be at the origin of an important psychic and social suffering. The more severe forms give rise to unsightly scars which prolong this malaise. Treatments to erase or mitigate them also exist. But before starting, it is necessary to consult a dermatologist who will be the only one to guide you on the methods to use for a better result.
Acne affects 80% of peoples worldwide, especially in adolescence. Of these, 15% develop severe forms and thus, after the acne disappeared, they left many unsightly scars, mainly on the face. But such scars are also possible to moderate forms with inflammatory relapses, in patients who have not followed their treatment well or in those who have manipulated their comedowns or other acne lesions.
The Different Types of Acne Scars.
Most often, acne scars are hollow and form small depressions, their size and depth being variable. They usually sit on the cheeks, the forehead and sometimes the chin. There are 3 types of hollow or depressed scars:
The scars in “Ice hockey shape”. They are fine, measuring 1 to 2 mm in diameter and a few millimeters deep.
U-shaped or cumuliform scars. Their diameter is wider than the previous ones but they tend to be shallower.
Wide scars with a straight border on the skin, relatively deep and quadrangular in shape.
But the scars can vary in shape, size and relief. Some scars are seen as small areas of depigmentation or (on the contrary) of hyperpigmentation without modification of the cutaneous relief. Others may be prominent and in some cases even hypertrophic or even keloid scars (in the form of an elongated bead), especially in black skin, especially in the posterior area of the neck.
Acne Scars: Therapeutic Options.
The characteristics, number and position of the scars as well as the general state of the patient’s skin, will determine the treatment or treatments to erase them as well as the sequence of each treatment. Only a dermatologist can define and guide the therapeutic choice and the order of the techniques used. These can be chemical, mechanical, surgical or laser. Here we discuss these different techniques.
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CHEMICAL DERMABRASION OR PEELING.
The peel is preceded by a local treatment with a cream with vitamin A for several weeks. A surface chemical peel is sometimes proposed before performing surgical treatment of hollow scars. It is made by using fruit acids and other abrasive substances. The aim is to eliminate the superficial layers of the skin (epidermis and sometimes the superficial dermis). The procedure may be performed under analgesics or under local or general anesthesia. No further intervention is carried out before the skin stabilizes. Some patients find, after a few months, that the result is satisfactory and do not realize other aesthetic interventions.
It has the same indications and objectives as the chemical peel, except that it is carried out mechanically generally with the aid of a rotary electric cutter with a rough surface. The level of abrasion is controlled by the speed of rotation of the cutter and by the pressure exerted by the physician.
LASER ABLATION TREATMENTS.
After surgery, ablative laser treatment (or thermal dermabrasion) is often necessary to re-set the residual scars for an optimum result.
Specific laser techniques are used to treat hyperpigmented or depigmented scars showing no relief from the cutaneous level. These thermal techniques are increasingly used, often in the first instance.
SURGICAL TREATMENT OF 3 TYPES OF HOLLOW SCARVES.
For ice scarred scars. These fine lesions usually touch the entire dermis and their treatment is done by excision by “coring” or “drilling” around the scar using a round bistoury under local or regional anesthesia. In this way, the scar is reset to the same level as the cutaneous plane. In case of numerous scars, several interventions will be necessary to avoid too many sutures. This technique makes it possible to erase the scar depressions but it is sometimes necessary to erase persistent irregularities at a later time by means of laser remodeling.
For U-shaped or cumuliform scars. Although shallower and less pronounced than the previous ones, U-shaped acne scars can be as annoying aesthetically for the patient. The surgical treatment of these scars consists of cutting them with a needle provided with a point in the form of scalpel, which causes the formation of a small hematoma that will fill the scar. For larger scars, an adipose tissue auto-transplant can be performed. However, currently, these scars are most often treated by fractional laser.
For large scars with a straight edge. Wider, visible and deep than the previous ones, these scars can be treated by excision then elevation of the bottom of the scar, or even by dermal graft or by auto-transplantation of adipose tissue. Most often, several interventions are necessary to obtain a satisfactory result.
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A few things to know before you get started.
Before embarking on the path of aesthetic treatment, it is important to know that there is no treatment or combination of treatments to completely and perfectly eliminate acne scars.
Treatments are generally reimbursed only by mutual (usually partially), except in case of severe scars after severe acne. But the game is worth the candle because at present it is possible to obtain a result quite satisfactory from the aesthetic point of view, with a significant reduction of the scars and variations of the coloring of the skin.
It is necessary to wait at least 12 to 18 months after the end of any active lesion of acne and inflammation before starting an aesthetic treatment to make disappear the scars. Indeed, the process of scarring (regardless of the scar) is long and requires months before the stabilization of the final scar. Doing care before you can have the opposite effects with the appearance of redness, inflammation, even the reactivation of acne!
Since the complete treatment lasts for some time (from a few weeks to a few months), it is advisable to carry out the care during the winter period to limit as much as possible the exposure to the sun, which could compromise the results.
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