I have a question about Fraxel, IPL, chemical peels etc. basically any treatment that gets rid of old acne scarring. I was told by a skin care doctor that those treatments will never totally fix the problem, and that your skin has a memory, and once you have a scar you can never get rid of it. I was told you can temporarily remove the layers of skin and scaring but it will eventually come back without regular maintenance. Can you clarify this?
Get Rid of Old Acne Scars?
Doctor Answers 6
Many options for removing acne scars
It all depends how deep you scars are. If scars are superficial you can get rid of them almost completely every time, but if you have deeper scars, you should expect significant reduction in depth and appearance. I would recommend Fraxel Restore Laser 5 to 6 treatments with skin preconditioned by specific topicals. This is very important step that we take with our acne scarring patients as this will lead to their great satisfaction with results.
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Acne scars can be treated by "deep" laser treatments
Because the oil glands are deep in the skin, only the deeper treatments can "get" to them. the Fraxel and Profractional lasers both do this safely, although repeated treatments of the "worse" areas may be neccesary. For acne scar treatment tio be effective, it needs to be about 800microns deep, the level of the scar.
Scars can be improved through excisions, resurfacing, fat injections
Scars can be improved through excisions, resurfacing, fat injections. It all depends on the type of scar you want to improve. If there involves a significant difference in the level of the scar you need to improve that mostly by excision. This is more so with depressed scars. There are many ways to try to elevate the scars including very strong chemical peels in the depressed scars which will elevate the scars. Subcision is a technique that can be used to incise around the depressed scar releasing the tethering component to allow the scar to rise up to the level of the surrounding skin. Or just excision which is the better choice because you make the ultimate incision smaller.
Resurfacing after the subcision or excision comes next and this is where the incisions are made to look less noticeable. Sometimes through acne, scarring is extensive in the subdermal and subcutaneous plane causing large areas to be adhesed to the deeper tissue. Filler can separate this scarring but the best thing for this is fat injections. Injecting fat into this large layer of scar will soften the adhesions and allow the skin to become more free. The extra volume also allows the skin to be taken up more reducing more lines and wrinkles and a coalescence of scars to make larger scars. Also with the layer of fat, the skin can begin to heal and remodel itself to make the skin look better.
I personally don't think fraxel works well for Acne scars. IPL can help with the vascularity of the scars if they are new or possibly any pigmentation issues of the scars but that is the most it will do. Chemical peels can help like any resurfacing but can be limited without changing the depressed or raised nature of the scars.
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Acne scars are hard to get rid of
You pose an interesting question. In my experience, treatments like the Roll CIT and DeepFX laser are best currently available, patients typically see some relapse in the scars over time. This means that after a year or so the acne scars are visible again. I think what happens is that the treatment stimulates collagen formation in the scar plumping it up, but over time if there are no further treatments, the new collagen slowly breaks down and scar is visible again. This doesn't mean the treatments failed, just that they need to be repeated once a year or so. We really like the Deep FX laser for acne scars as it takes 4-5 days to heal, and people look good fast.
Deep ice pick style scars are better treated with minor surgical procedures that excise the scar. Surgical treatments are pretty much permanent.
I haven't found much success in acne scars with the Fraxel, IPL or chemical peels.
Hope this helps.
Difficult to get rid of acne scarring completely
Your skin does have a memory and it is difficult to get rid of acne scars completely. To some extent the potential results depend on how superficial your acne scars are. If you have superficial scars and wanted to undertake a dramatic procedure like CO2 resurfacing then you would probably be able to eliminate or almost eliminate them completely.
We do agree with your physician that the procedures you noted might not completely eliminate your acne scars. Here are a few others you may want to consider besides the ones you noted.
- CO2 Laser Resurfacing
- Erbium Laser Resurfacing
- Subcision (surgical)
- Punch Excision (surgical)
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.