I have tried almost everything to get rid of my severe acne, but nothing seems to work in the long-term, so I am starting to think I need to consider a more drastic solution. When is surgery an appropriate and effective acne treatment?
When is Acne Surgery the Best Solution to Treat Acne?
Doctor Answers 38
Ice pick scars, bridging scars, tethered scars
1. Ice pick scars- treatment with punch excision and a suture
2. Depressed scars- punch elevation and dressings
3. Bridging scars, - excision with sutures
4. Tethered or anchored scars- subscion, repeated 2-3 times
Always pick a treatment based upon your scar type. Laser is not the only answer, surgery, TCA CROSS and RF as well as lasers all play a role in acne scar management.
Dr Davin Lim
Thank you for your question. The last solution to treat acne is Accutane, a form of Vitamin A. Accutane is used to treat severe nodular acne. It is usually recommended after traditional therapy has failed. I would recommend consulting a Board Certified Dermatologist for safest and best treatment option. I hope this helps.
Effective acne treatment
One should work with an experienced board-certified dermatologist to review comprehensive approach to treat active acne, prevent acne scarring and to treat existing acne scarring. Acne is a multifactorial skin condition, e.g. genetic predisposition, hormonal trigger, stress, thus requiring a multi-pronged approach. There are topical and oral prescription medications available to minimize cystic acne lesions, suppress hormonal trigger, and achieve more even tone. Scar revision may be considered with combination of punch excision of ice-pick scars followed by Fractional CO2 laser resurfacing once the acne is relatively quiescent
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Acne scar Surgery - Best time
Treatments like intralesional steroid injections to cystic acne do help in treating severe and resistant cysts. But if there is a lot of active acne, then scar surgery is best held off for when there is less activity.
We do combine treating scars with treating acne - newer evidence suggests combining treatments like scar revision, peels, and lasers for acne scars with isotretinoin, and there has been no adverse effects like keloids or hypertrophic scars in our experience, which is in agreement with current publications. And this is in skin types IV/ V/ VI, in South India.
Acne scars - a multimodal approach
1) fractional laser resurfacing - CO2 is ideal for lighter skin types who can tolerate some downtime and usually requires one treatment. Radio frequency treatments are better for darker skin types or those who don't want as much downtime. They usually require several treatments.
2) Subcision techniques to break the tethering between the base of the scar and the underlying tissue. This is usually coupled with dermal fillers to help occupy the newly released space. Treatments are often repeated yearly, with improvements seen with each treatment as the untethered skin starts to remember it's less tethered state
3) Sculptra - is a specialized filler that builds collagen and when injected superficially, has also been found to help remodel the skin under the the acne scars
4) Ulthera - is a non-invasive approach to tightening the skin via collagen formation to help tighten the appearance of acne scars
5) Profound - is a minimally invasive radio frequency microneedling approach that stimulates Elastin, collagen and hyaluronic acid formation in the skin. It also shows promise in helping with acne scars, but does require more study.
6) maintenance therapy with chemical peels, microdermabrasion and skincare are also important measures.
7) keeping good control of any active acne is also important to help maintain a healthy looking skin and mitigate against future scar formation.
A consultation with a board certified plastic surgeon or dermatologist who has these multimodal approaches will be a great way to customize an approach for you.
Solutions for Acne
Acne Scarring Treatments
Acne Surgery Just One Part of Treating Acne
Acne surgery alone is not the best solution to treat acne, rather it is one option of many. Acne surgery isn't even appropriate for all types of acne. Acne typically necessitates medical treatments such as over-the-counter and presciption topical medicines and/or prescription oral medications. Acne surgery is typically considered "adjuvant" therapy and will be more effective if used in addition with a medical acne regimen. There are also office-based treatments such as Isolaz, Silkpeel Dermalinfusion or chemical peeling that can be helpful in treating acne. Everybody's skin is different and every acne case is different requiring a different regimen. I recommend you consult with a board-certified dermatologist.
Acne Surgery is just one piece of the puzzle
Acne is a condition where many different treatments can be used. Topical and oral antibiotics, retinoid creams, benzoyl peroxide, salicylic and glycolic acids, birth control pills, and laser treatments may be utilized in a treatment regimen. Accutane is usually reserved for more severe cystic acne that doesn't respond to the above treatments. Acne surgery is a good option as part of the regimen for open and closed blackheads, but it is not used as a single treatment. A board certified dermatologist can tailor a good regimen for your specific acne type.