Acne Scar Revision On Accutane At A Glance
- Best Results2-8 sessions
- Treatment Recovery2-4 days
- Procedure Time20 min
- Skin SpecialistDermatologist, nurse
- Duration of ResultsLife
- AnaestheticNumbing
- Back to Work1-3 days
- Cost$-$$$
Acne Scar Revision On Accutane / Oratane
Acne scars are best treated early (less than 3 months old). With revised guidelines in 2016, patients on Accutane-Oratane are able to undertake most scar revision procedures. Treatments include vascular lasers, focal deep peels, minor skin surgery & fractional lasers/microneedling. Early treatment can often reduce the requirement for more invasive future procedures.
FactsFacts on Treating Acne Scars On Oratane
- Recent guideline revisions in 2016 & 2017 have changed the way we manage acne scar patients on isotretinoin
- Early remodeling of scars mitigates more invasive procedures
- There is a paradigm shift amongst procedural dermatologists to treat scars early
Acne Scar Revision
Essentially all scar revision procedures can be safely performed on patients on oral isotretinoin, apart from fully ablative lasers & deep global or segmental peels. This consensus has been revised in 2016 & 2017 in peer-reviewed journal publications reflected on evidence-based medicine.
This means the following procedures have no higher risks cf. patients, not on oral isotretinoin- microneedling, Dermarollers, Dermastamping, fractional lasers, nano RF/Sublative, RF microneedling, focal deep peels, Tixel, steroid injections, punch excision & elevation, limited surgical subcision.
Out of courtesy, either I or one of my colleagues will inform your supervising medical dermatologist of the intent of scar revision procedures.
What procedures can not be performed on Accutane?
As per revised guidelines, fully ablative laser resurfacing procedures including CO2 & erbium laser can not be performed whilst on Accutane. Deep segmental & global peels with TCA or Phenol Croton are also excluded (note this is different form TCA Paint, CROSS as this is classified as focal deep peels). Extensive surgical procedures are also excluded. This includes complex flaps, extensive excisional procedure should be limited. Subcision can be performed with caution.
Discuss these procedures with your dermatologist or plastic surgeon as they would be familiar with the JAMA guidelines. If they have not read the current literature, you may be enforced a 6 to 12 month washout as per original reports from the 1980s.
What are the official guidelines for procedures?
Official PI or Product Information for Oratane – Accutane still stands at a 6-12 month washout. Companies are too lazy to update their policy based upon published safety data over the past four decades.
Your dermatologist may not read journal articles, & hence may choose to follow outdated information.
Why is early management of acne scars optimal?
There has been a paradigm shift in the management of acne scarring over the past decade. Evidence points to early management of acne scars as the standard of practice. With early intervention, the requirement for more invasive treatments such as fully ablative laser resurfacing & invasive surgery may be mitigated.
View our Treatment Gallery
What are some of my favourite ways to treat early acne scars?
The whole idea of early scar remodelling is to improve scarring early. This has many implications including reducing the requirement for more invasive procedures, as well as psychologically assisting the patient for improved confidence & outlook. Our most utilized procedures include-
- Vascular lasers for red scars.
- Pico lasers for brown scars.
- Tixel for depressed scars.
- Focal TCA for ice pick & box car scars.
- Fractional lasers for atrophic scars.
How can I treat red marks or post inflammatory erythema?
PIE or post inflammatory erythema is a common form of acne scarring. In most cases, it fades within 6-12 months. For faster resolution, I use vascular lasers. This form of laser treatment is safe for patients on Accutane.
Most patients require 2-4 sessions over a course of 3 months. We use various devices including the VBeam Prima, the Perfecta, Laser Genesis & IPL/BBL.
Book an appointment with my clinical nurses for treatment options.
Revisions have been made regarding the concomitant use of #accutane #oratane or #isotretinoin with procedures such as lasers, #IPL, #BBL, & chemical peels. At the end of the day it is up to the comfort level of both your #dermatologist & operator as to the level of intervention whilst on this medication. Many large multicenter studies have been published in 2016 to 2018, so the safety is well known👍🏻
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🔬Skin Science: Early reports suggest that #accutane & lasers/peels don’t mix due to increased risks of scarring .This has been corrected over the past 5 years. In summary, you can’t have fully ablative lasers, you can not have segmental or global medium depth peels or deeper. Rule modified according to #retinoid sensitivity including mucocutaneous side effects
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👉👀Who To Ask? Your dermatologist & or your operator. Hopefully they would have kept up with the times & reviewed the journal articles 📚
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😎Dr Davin Lim
Dermatologist @101.skin
Brisbane 🇦🇺
.#skincaretips #skincarescience #dermalscience #instaskincare #skincareroutine #retinoids #retinol #accutanetips #simpleskincare #beautytips #beautyscience #dermaltherapy #aesthetics #drdavinlim
One has to understand aetiology & histology in order to effectively manage acne scars. Ice pick scars are a common subgroup of #acnescars
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🔬Skin Science: Abnormal differentiation of follicular orifice coupled with increased sebum leads to proliferation of the commensal c.acnes. Inflammatory response with massive cytokine release destroys adnexal structures including pilosebaceous unit, eccrine & apocrine glands in addition to dermal matrix consisting of #collagen, elastin & hyaluronic acid. This leads to deep dermal & subdermal fibrosis
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📝In English: Essentially clogged oil glands gives rise to big angry oil glands, eventually exploding, in turn results in deep holes & deep scars
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👍🏻Understanding the depth of ice picks can explain why if one performs #subcision under the icepick, you can feel the amount of fibrosis. In some cases it extends into the subcutaneous tissue. Icepicks, by definition, are longer than they are wide. I do think there is a spectrum which goes some like this- enlarged pores (etiology is different, but can be classed here as treatments are very similar), pits, picks, shallow ice picks, & classic ice picks
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👀Treatments: Include #TCA CROSS, Paint or Drip, punch excision, excision, laser, nick and sew. Even fractional laser to the walls of the scars can improve this type of scarring
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😎Dr Davin Lim
@drdavinlim
@cliniccutis
Brisbane, 🇦🇺
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#scars #nomorescars #dermatologistbrisbane #skinspecialist #skinbrisbane #brisbanedermatologist #acnescartreatment #scartreatment #scareraser #acnescars #icepickscars #drdavinlim #davinlim#scarjourney #icepickscars #acne #skinrejuvenation
How can I treat brown pigment or post inflammatory hyperpigmentation?
Brown acne scars are called post-inflammatory hyperpigmentation. They have classified as Grade 1 scars. This form of pigmentation takes longer to resolve compared to red marks. 50% will last over one year, 25% of these last five years or longer.
This form of pigmentation is best treated with creams, sunscreen & gentle nano, or better still Pico lasers. 3-5 sessions are conducted over 3-5 months.
What skin care products can I use whilst on Accutane-Oratane?
Be guided by your treating dermatologist as this is a controversial topic. It is important to understand that your skin’s barrier is compromised whilst you are on oral retinoids. It can take 4 to 12 weeks before your skin feels ‘normal’ after your Accutane course.
In some cases, your medical dermatologist may encourage you to apply a topical retinoid or retinol- if your skin can tolerate it. For this to happen, you must take extra precautions such as appropriate moisturizer & sunscreen use. Additionally the dose of isotretinoin should be equal to or less than 20 mg per day. Check with your supervising dermatologist.
If you have any inflammatory lesions (red marks) or evidence of PIE (red scars), the use of niacinamide B3 may help. Red marks are best treated with vascular lasers (permitted on Accutane).
What DIY procedures can I do for my acne scars?
Based upon the literature review & the safety data, there may be some DIY procedures that can be implemented safely at home. This includes stamping procedures with needles no longer than 0.1 to 0.2 mm.
Infection risk is increased in patients on Accutane as this drug changes the colonization of bacteria, in particular s.aureus. On this basis, my standard of practice is an antibiotic cover for the healing time frame of any procedure.
On this basis, my recommendations are that you clear this up with your treating dermatologist. Do not disrespect their decision as they are supervising your treatment – I am not. These are my recommendations based upon literature review with careful consideration to side effects.
NB: I am a procedural dermatologist. I do not prescribe Accutane, I do not supervise medical treatments.
How much are treatments?
Treatments are cost effective as these are performed by my procedural nurses. As a guide-
- Vascular laser $290-$390 per session (Nurse)
- Tixel $290- $490 per session (Nurse)
- Fractional Laser $590- $990 per session (Nurse)
- QSL Dermal Toning $690-790 for 5 sessions (Nurse)
- Pico Lasers $390-$590 per session (Nurse)
For an obligation FREE consultation, book an appointment with my clinical team.
Note: My work is primarily focused on management of severe scarring with surgical procedures, ablative lasers & deep peels. Costing will vary depending on the complexity of the procedure. Most of the cases that I do will carry a Medicare Rebate.
How do I get started?
You have a few options. Firstly a referral to me from your treating Dermatologist would be a good starting point.
If you would like cost-effective treatments, book a consultation with my procedural nurses at Clinic Cutis. They have the experience to assess your scars & implement a cost-effective treatment plan.
Davin’s Viewpoint on treating acne scars on Accutane
The revisions 5 years ago has now enabled patients to undertake sensible scar revision procedures. Most procedural dermatologists agree that early intervention of scarring is best practice.
Even depressed scars can be effectively improved with combination treatment such as vascular lasers & Tixel resurfacing. For post inflammatory hyperpigmentation, the use of bleaching creams & pico lasers are highly effective. Red scars do very well with vascular lasers.
Treated early, most patients will not require invasive surgical procedure.
