Which acne scar treatment options are best for correcting uneven skin tone and skin texture? (photo)

Doctor's Answers 3

from the photo, it seems you are suffering from atrophied scars, post - acne erythema marks (redness marks) and post-injury hyperpigmentation marks. These can be attributed to your previous acne flares.

In my practice, I have at my disposal, an array of treatments to offer patients with skin texture and colour tone irregularities from acne injury.

Some of the procedures I do for my patients include-

1. FOTONA Erbium YAG resurfacing- this program gives out laser energy beams of 2940nm wavelength, which encourages collagen production, while causing resurfacing on the skin surface, producing a smoother, tighter complexion. Power can be calibrated to target different severities of acne scars.

2. FRAC3 laser rejuvenation- a revolutionary, multi-mode, long pulse Nd:YAG laser to improve surface irregularity, enhance pore refinement. This laser can be used to reduce skin redness as well as telangiectasia (fine blood vessel formation).

3. Subcision- this is a needling technique, where I will use needles of varying sizes to treat larger, depressed scars. The aim of the procedure is to ‘surgically release’ the depression brought upon by mini fibrosis bands holding the skin surface down. A numbing injection will be given prior to the procedure to entire optimal comfort.

4. Rejuran Skinhealer - this is an innovative and revolutionary injectable product that is fast gaining popularity. Rejuran is made up of purified polynucleotides (DNA fragments) from salmon. It’s strength is in enhancing the regenerative and repair properties of the skin. Prior to its use in Aesthetics, polynucleotides have been used in the treatment of skin burns, skin wounds, and other surgical procedures.

Rejuran is injected for the full face, and will also be concentrated on areas that need further repair, e.g. atrophied scars. I frequently combine both laser resurfacing as well as Rejuran treatments for my patients for the best outcomes.

  1. Dermal Filler injection. This classical procedure is timeless as it is highly effective in lifting depressed scars, volumizing depressed regions, and even aid in hydrating the skin. The key to performing a dermal filler procedure well for acne scar patients is the selection of the scars to treat (not all scars can benefit from direct filler injection) and of course the type of dermal filler to use.

6. Other treatments. There are other treatments including and not limited to TCA CROSS, High-intensity Focused Ultrasound, nano-fractional RF, etc. My specific treatment plan for patients will not include all available modalities, but rather, it will be customised to the patient's requirements.

Hope that helps.

Cheers!!

Warmest regards

Dr Heng Wee Soon

From the picture given, your uneven skin tone and texture is due to a combination of acne scars (mainly atrophic and rolling scars, with a few ice-pick scars) and post-inflammatory hyperpigmentation (PIH) from acne that you had previously. Options for treatment in your case will include:

1. Radiofrequency Microneedling (INFINI) treatment – this “volumizing” treatment will improve the scars greatly by stimulating collagen synthesis via the different depths of the insulated microneedles.

2. PicoSure Laser treatment – Harnessing the picosecond laser technology and its patented focus lens technology, acne scars can be treated with better results and shorter downtime compared to traditional fractional laser resurfacing. At the same time, the PicoSure laser toning can treat the PIH as well.

3. Fractional CO2 laser – this works by ablating scars away and creating microthermal zones that are surrounded by healthy tissue, allowing for healing and collagen production to even out skin texture and scars.

4. Polynucleotide injections e.g. Rejuran – Through various biological and cellular mechanisms, polynucleotides enhance DNA repair, accelerate tissue repair, reduce inflammation and improve skin texture by increasing collagen synthesis. This results in improvement of acne, scars and hyperpigmentation.

5. Subcision – This procedure using a special form of needle called the Nocor needle is particularly useful for depressed and rolling scars where there is a lot of a fibrous tethering in the underlying skin. By freeing up the fibrous tissue beneath, the depressed and rolling scars usually become shallower and allow for other treatments like lasers to work better subsequently.

6. Dermal fillers – This is particularly useful for isolated atrophic small scars to restore volume to the depressed scar area, and is sometimes done in combination with subcision to give better results.

7. Trichloroacetic Acid(TCA) CROSS – This treatment uses tiny amounts of trichloroacetic acid to improve scars, hence the synonym CROSS - chemically reconstruction of skin scars. This is particularly useful for small ice-pick and atrophic scars.

In my practice, no one patient is the same and each individual needs to be assessed properly and a detailed customised plan of treatment is done. In most cases, a combination of the above treatment gives the best results.

In your case, from the picture given, I would recommend a combination of PicoSure Laser Toning to improve the shallow scars and PIH followed by subcision and radiofrequency microneedling to improve the deeper scars.

When I saw your picture, I think the main concern you would have is the textural uneven-ness that has occured due to the past acne flares. As such my preference would be to first treat the un-even appearance and slowly work it towards the surface imperfections.

1) Subcision with some filler placement (preferably Radiesse) is one of my favourite treatments as the breaking of deep scars and plumping up through filler placement would result in a more even appearance

2) Intersperse that with Fractional CO2 treatments which would aid in collagen synthesis and also improve the surface imperfections. However I would caution against close intervals AND too many sessions as I have seen a fair number of patients with sensitive/raw looking skin post laser.

3) Some TCA Cross for the icepick scars,

4) Adding some Q switch with suitable topical products would help reduce the redness/PIE from the acne flares.

However please be cautioned that scars can maximally only improve 75-85 percent, so expectations must be moderated by the doctor together with the patient.

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Hi, Realistically, 25-50% improvement will be achievable with combination acne scar therapy (these include subcision, scar revision, fractional CO2 lasering, fractional microneedle RF and fractional picosecond lasering) for moderately severe acne. Generally, after treatment, scars will still be present but will look less obvious, less deep and less craggy. Complete removal of acne scars is not possible even with repeated treatments and with the “best” treatments. Hope this helps!

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Hello Bemme Thank you for your question. You can try topical retinoids (retin A/ differin) which will help with mild acne scars, acne control, skin texture and oily skin. Use it at night for 1 to 2 months, and you should be able to see some results. However it is not enough to shrink your pores. A fractional resurfacing laser or microneedling fractional radiofrequency treatment can be done in combination for better results and more severe acne scars and uneven skin texture. It will also improve small to medium sized pores. Speak to a doctor to find out more. Hope this helps!

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