I have just completed accutane treatment and during my 6 month downtime I am researching the best way to eliminate or reduce scarring that I have from years of severe acne. I have all 3 types: rolling, boxcar and icepick. I also have major hyperpigmentation that has left my face much darker than the rest of my body. I'm glad to have cleared the acne but the scarring is just as hard to deal to with. Help! :-(
What are the best, most effective treatments (peels, surgery, resurfacing, etc) for African-Americans with acne scars? (photo)
Doctor Answers 3
Treatment of acne scars in African Americans
Thank you for sharing your photographs. In my office we have gotten excellent results in patients like you with a series of modified Jessner's peels. This method is a popular choice as there is usually no preparation required, little to no down time (except a predictable 24 hour period in which there is significant skin peeling), it is effective, economical and generally well-tolerated skin of color in our hands. Good luck!
Subcision, Fractional Dermabrasion, & Chemical Peels Work Well For Acne Scars in People of Color
Since, as in this case, acne has left a variety of scars, a tailored approach to treatment that combines several treatment modalities has been in my experience the best approach and the most likely to result in gratifying results and patient satisfaction.
Subcision (aka Dermaspacing) can be helpful for rolling and box scars. Subcision, which takes only minutes to perform, is a procedure carried out under local anesthetic. Once numbed, a small sterile needle is inserted below the scar and moved in all directions in order to break up the abnormal, fibrous collagen bands of scar tissue that are pulling the surface downward and causing the depression. Freed from its bonds, the surface of the scar is able to float upward toward the surface. Moreover, the procedure stimulates new, normal collagen formation (neocollagenesis) and this fresh collagen then serves as a natural buttress to hold the scar surface level with the normal surrounding skin. Optimal results are generally obtained after a series of two to four treatments spaced at six week intervals.For many people, just smoothing the scar in this fashion (and eliminating the shading "craters of the moon" effect) is sufficient and gratifying improvement.
For people of color in particular, I have found that a series of fractional dermabrasion (aka fractional microneedling or medical microneedling) treatments treatments to be helpful for pit scars and dilated pores and to some extent for improving the troubling hyperpigmentation.
Microneedling, which may be performed either manually with a roller or a motorized device using only topical anesthesia employs an array of needles that pierce the surface of the scar to break up the surface tissue and create microchannels. This, too, allows for new collagen formation, but also makes possible the transferring (auto-transplanting) of functioning pigment producing cells from the surrounding normal area into the scar area. Fractional dermabrasion, like subcision, yields best results when performed as a series of two to four treatment sessions at six week intervals.When desired, subcision may be performed at the same time as medical microneedling in order to hasten the process.
A series of superficial chemical peels, using glycolic acid, Jessner's solution, or salicylic acid can further help to lighten the hyperpigmentation and have proven safe in people of color. Stronger chemical agents and deeper peels, such as the CROSS therapy for pit scars, should be avoided in people of color owing to the risk of inducing permanent, complete and irreversible loss of pigmentation.
Not all aesthetic physicians perform fractional dermabrasion and subcision, so, should you wish to explore these simple, minimally-invasive options, you should screen carefully for a board certified aesthetic physician with training and expertise in the procedure.
Acne "scars" and hyperpigmentation in an African American
From your photo you really have only a minimum of scarring, but you do have very large pores, many of which show increased pigmentation. You also show other areas of hyperpigmentation, a common consequence of previous inflammation from acne in darker skin types. Because lasers and dermabrasion in African Americans is very risky due to altered pigmentation or keloid scarring, I would not recommend that for treatment. However, topically applied retinoid cream will lighten pigment and shrink pores to some extent, and glycolic peels can also be helpful as would microdermabrasion.