I am a Hispanic male in my mid 30's and I want to do something about my acne scars. I am a Hispanic with olive skin and am considering one of the Fraxel laser treatments. I have moderate/severe boxcar and rolling scars. I am very nervous about the possible complications that laser treatments carry with olive-skinner individuals. What is my best option for treatment?
Olived Skin Hispanic with Acne Scars (Boxcar/rolling) - Best Treatment?
Doctor Answers 4
Acne scar treatment in darker skin types
I treat a large number of patients who are tanned or have naturally darker skin. My treatment of choice for deep acne scar in such patients is direct excision of the larger acne scars followed by wire brush dermabrasion. We place all patients on hydroquinone based creams for at lest 3 weeks prior to procedure to lessen the chance of post-procedure hyperpigmentation. With dermabrasion long term pigment loss is quite rare (I have never seen it in my practice), making it the safest resurfacing treatment method for most patients (even more so if you have olive skin). On a different note, deep dermabrasion (which is becoming a lost art) is also very effective in reducing the acne scarring. Hope that is helpful. All the best, Dr. Vartanian from LA.
Treating acne scars in dark skinned patients
Acne scars in dark-skinned patients are a common problem. I treat a great many patients for this condition. I find that boxcar and rolling scars respond best to surgical treatment including subcision and excisions/dermal grafting. I do not feel that lasers are the primary modality for treatment but rather a second line of treatment once the surgical procedures have been used to maximize skin contour.
Subcision may be best option for acne scars that are depressed in patients of color
Subcision may be best option for acne scars that are depressed in patients of color. In this procedure a 1mm knife at the end of a surgical needle is used to break the scar beneath the skin, minimizing any chance of color change of the overlying skin.
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Darker skin types should approach some laser technology with caution
Patients with inherent pigment to their skin can be a challenge for treating physicians. In Southern California with treat a preponderance of patients with Hispanic, Asian, or Middle Eastern heritage, in addition to tanned Caucasian skin--all of which may pigment following laser or light technology treatment. "Fraxel" treatment can mean several things--both nonablative and ablative laser resurfacing technologies.
Boxcar and depressed acne scar treatment can be challenging. I often counsel patients to have realistic expectations. We can't return skin to its native state pre-scarring, but we can make great improvements. Some boxcar scars/depressed scars are tethered down by scar tissue. These respond well to a combination of removal by punch excisions or subcision with immediate filler or fat micrograft placement. Longer-acting volumizing agents such as Radiesse and Sculptra Aesthetic have also been used to treat areas of acne scarring.
An interesting and developing area laser/light treatment for darker skin types may be the use of infrared & radiofrequency sublative devices for the treatment of acne scarring. A study conducted during my surgical fellowship found that darker skin types (Fitzpatrick skin type IV) had improvement in acne scarring using this technology without any subsequent hyperpigmentation.