Botox is not my first choice

Botox is great for many things, but for acne scars it is a stretch.

Acne scars are never easy to treat. First , the people who get the scarring are genetically prone to scarring. Many people get acne without the scarring sequellae.

Our amamentarian with regard to acne scars is;

1- Prevention - this is the obvious choice. acne can be treated with Benzoyl Peroxide, Retin-A, Topical and oral anti-biotics, accutane, manual treatments to treat the pores and blackheads, and now the latest treatment - a laser that is designed to reduce acne.

2- Scar reduction-

scars come in several types;

small acne scars - look more like cobblestone skin

Ice Pick scars - look like a small round hole- like an ice pick was stuck into your skin.

Larger acne scars - not as deep as ice pick scars, longer and wider.

Treatments-

For treatment of the small acne scars and larger acne scars - dermabrasion, laser resurfacing and subcision with a filler are all good treatments.

For ice pick scars - subcision with filler are the only adequate non-surgical treatment. They can also be remove by excision and closure of the ice pick scar.

warning:

all treatments should be on hold until acne is no longer active.

All treatments must be postponed until at least a year after accutane is stopped.

In the group of patients that get acne scarring, any treatment should be limited to a test trial area to see what the results look like. Nobody wants things to look worse as a result of the treatment.

Robert M. Freund, MD, FACS

New York, NY

Hello Blythe,

I have been using Intradermal Botox injections for oily skin, large pores, fine wrinkles, "blotchy" skin and acne sequlae (red / brown spots) and have been seeing very satisfying and pleasing results with my Patients.

Based on my experience with Intradermal Botox for these other conditions,  I feel that it would certainly be worthwhile for you to consider a treatment with Botox to help improve the appearance of your scars.

The Botox would work by providing some "relaxation" to the skin surrounding the scars much in the same way that pores are reduced - this could potentially improve the appearance of your scars.

Also fillers could be used in combination with the Botox to help improve portions of the scars that are "sunken".

The good news with Botox is that an experienced injector can provide you great results at a reasonable cost and high safety profile.

Take Care, Dr. Jafri

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Blythe, Whenever you are considering improving the skin, whether for cosmetic reasons or reconstructive (or anywhere in between), it is best to approach the skin from the structural, biochemical and mechanical aspects. This multimodal approach promotes improvement in the skin dermis, health and stress, respectively.

For the structural component, medications such as Retin-A help to improve the underlying collagen framework. For the biochemical component, eating healthly and taking antioxidants (and avoiding smoking) helps considerably. For the mechanical component, Botox helps significantly reduce the stress on the dermis. By preventing contraction of the underlying muscles, Botox allows the healing process to occur without the added stress of constant movement of the skin.

Additionally, Botox blocks the sweat glands in the skin. This can also be useful in avoiding irritation of the overlying skin. In addition to the medical approaches outlines above, you may want to look in to interventions such as laser which can sometimes help with scarring as well.

I hope this is helpful.

Dr. David Shafer

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There is no physiologic reason for Botox to be effective for directly softening acne scars.  As you probably already know, Botox works by weakening muscles of facial expression.  The reason your forehead became smoother is that there is a muscle in the forehead that was weakened, causing an overall smoother contour to your forehead skin (as it usually does). 

The effect was not a result of injection into the acne scars.  The effect that Dr Jafri describes in the cheeks is more likely an effect of inserting a needle into the skin.  This traumatizes the skin causing edema or swelling, thus temporarily flattening the acne scars. 

The Botox is probably an innocent bystander.  Seek out a physician in your area that does a procedure called "needling".  It may give you the effect that you are seeking without any risk of paralyzing your smile muscles.  Good luck!

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Botox is not used for atrophic scarring secondary to acne. Botox is best for facial lines of animation commonly treating the upper 1/3 of the face.

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