Acne Scars At A Glance
- Best Results1-6 treatments
- Treatment Recovery0-9 days
- Procedure Time15 to 90 min
- Skin SpecialistNurse, dermatologist
- Duration of ResultsYears+ to permanent
- AnaestheticNumbing to sedation
- Back to WorkImmediately- 7 days
Acne Scar Treatments
Acne scarring is my specialty. My method of scar revision is aimed at treating each and every scar with the optimal treatment for that scar. Meticulous planning & mapping, together with angled photography provides a treatment plan for your scars. My point of difference is that I primarily use my hands, using lasers when appropriate.
FactsFacts on Acne Scar Treatments
- Acne scars, no matter how old or severe can be improved
- 3 factors determines treatments- skin type, scar type & downtime
- I use techniques such as subcision, deep peels, surgery, lasers & other energy devices
- Each type of scar will have an optimal treatment
- Matching scar types & skin types to scar treatment procedures is the key to success
- On average, 70-80% of acne scars can be improved with bespoke revision
- In most cases a Medicare rebate applies
How much improvement can I expect from our treatments?
Acne Scar Treatments
On average, patients will receive at least 70% global* improvement with a scar management program. Some patients with predominantly ice-pick & box car scars can expect up to 95% improvement.
Quantifying improvement by objective measurements is important. I prefer to use the ‘distance rule’ to gauge improvements. More on this topic later.
* What does global improvement mean? It means that taken as whole, the majority of scars will improve. It does not refer to that one specific scar you can see with a mirror held 20 cm from your face at a certain angle of lighting.
What makes my method of acne scar revision unique?
My method of scar revision is based solely on finding the optimal treatment for each scar. Often it is manual work, namely I use non-laser methods to treat scarring. I only use a laser or energy devices as it pertains to the scar type.
I photography & map each scar type. New artificial intelligence software maps scars three dimensionally. This allows for accurate progress during your scar revision journey.
Most patients will have mixed scars, namely rolling scars, box scars, ice-pick and anchored scars. This means that multiple modalities are needed including surgery, peels, & in some cases lasers.
Each type of acne scar will have a best form of treatment associated with it. Our technique matches the treatment to the scar type.
Why are manual methods better than laser packages ?
Have you ever seen a carpenter make a table with only a hammer, or a dentist with only one drill, or a mechanic with only spanner? The same analogy applies to scar revision. In the context of what I do as a dermatologist, my work is 100% manual. I employ devices, lasers & instruments pertaining to the job.
As a guide, for severe rolling scars, my work is primarily surgical subcision. This entails mapping out areas, finding the level of scarring intra-operatively, & then applying instruments to treat those scars. Manual treatment of acne scaring is Gold Standard.
What severity of acne scars do I treat?
The majority of my work is focused on the treatment of objectively severe acne scars, or scars recalcitrant to previous treatments. Severe acne scars are defined as scars that can easily be seen at conversion distances by normal people & can not be adequately camouflaged with make up in women or beard hair in men. (Severity should not be gauged subjectively).
Severe scars can be categorised as medical treatments, & in most cases a Medicare rebate will apply. Having mild to moderate scars does not mean I will not treat you, it means that you may not get a Medicare rebate for your treatment.
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Does it mean that if I don’t have severe acne scars I can not get treatment?
No, in most cases I can help, however if you have subjectively significant & ‘severe’ scars, but objectively mild or insignificant scars (your family & friends can guide you), I may not be the specialist for you.
For mild to moderate cases of scarring, I usually refer treatments to my clinical nursing team to perform. This applies to cases where surgical treatments are NOT indicated.
* I do not have an interest in treating BDD or Body Dysmorphic Disorder. How to assess ? Can be difficult. If you only see scars that are visible with certain downlight at at certain angle with a mirror held at 10 to 30 cm, chances are you have BDD. In this case working with a dermatologist who has in interest in treating this problem will be beneficial. I have no interest in the field of BDD as this requires counselling – often with psychologists & psychiatrists. The last thing BDD patients require are invasive surgical operations.
What types of lasers do we use to treat acne scars?
I employ lasers or energy devices based upon the scar type, skin type & downtime of the patient. In cases that are applicable, the devices I use include-
- CO2 Fractional eCo2
- Erbium Sciton Profractional laser- this laser is excellent as both an ablative as well as a fractional laser. It is especially good for Ethnic skin and deep rolling and atrophic scars.
- Erbium Fully ablative laser
- CO2 CORE Fractional laser
- CO2 fully ablative laser Ultrapulse
- C02 Mixto Fractional laser
- V Beam vascular laser
- Tixel for early scars
- RF miconeedling with Infini & Genius RF
- Picosure & Picoway lasers for brown pigment
- RF eMatrix RadioFrequency
- RF needling ePrime
- Fraxel laser (if I am really desperate & all other pieces of equipment are down)
In many cases I employ 2 or more devices if required.
What are fractional lasers and how do they work in acne scarring?
Fractional lasers include CO2, Profractional, Pico Fractional & Fraxel. They all work by treating ‘fractions of the skin’s surface’ using columns of laser, depending on the wavelength. The ‘fractions’, power, and depth can all be controlled by a laser specialist to deliver optimal results with minimal downtimes.
At Clinic Cutis we have over a dozen fractional lasers, depending on the job & skin color of the patient.
Is fractional resurfacing the best treatment for acne scars?
No. The ideal treatment depends on many factors including the type of scars, your skin type (ethnic origin) and your downtime. For superficial acne scars such as box car & shallow pick – icepick scars, lasers are appropriate adjunctive treatments.
When is TCA CROSS or Paint used for acne scars?
TCA CROSS stands for TriChloroAcetic Acid Chemical Reconstitution of Skin Scars. This technique was invented over a decade ago and still remains as one of the best methods to treat deep acne ice-pick scars, box car scars & enlarged skin pores. Most patients will require 2-4 treatments for best outcomes.
I apply TCA using methods such as tooth pick, syringe, brush & gauze delivery. In some cases I use phenol croton oil peels.
What is subcision?
This is a surgical procedure, designed to treat deep tethered acne scars. It is essentially key hole surgery of the face.
All scar revision specialists now perform cannula subcision as this is infinitely better than hypodermic needle ‘point’ subcision. This procedure is done under sedation. Subcision essentially breaks scar tissue from underneath. It is most useful for atrophic rolling scars, but can be used to treat icepick scars (the scars beneath the picks) as well as polymorphic acne scars.
In most cases I perform subcision along with other procedures such as TCA CROSS or laser resurfacing.
What is the role of fillers for treating acne scars?
Fillers are excellent for the treatment of atrophic & depressed acne scars. The advantage of fillers is that results are instant and downtime zero. Some patients will require 2-3 treatments for best results, other patients will require only one session.
How you respond depends on many factors including the depth, location of the scars, & whether depressed scars are tethered to underlying structures. In the majority of times, subcision is performed during the filling session.
I employ many types of dermal fillers including HA fillers & collagen stimulating fillers.
An important concept to understand is that all scar revision procedures rely on your immune system to repair & remodel collagen, in some cases adipose or fat tissue. If your immune system can not replenish collagen, you are left with 2 choices- fat transfer or dermal fillers. That’s it. Pros & cons of each to be discussed if this pertains to you.
What is the role of skin needling for acne scars?
Skin needling is an entry level treatment for acne scars. It gives modest improvements however It is especially useful for mild & early scars. Using a 0.1 to 0.25 mm derma roller at home can improve acne scars. As a guide-
Use a 256 to 512 Needle Derm Roller (from eBay)
Use every 2-4 weeks
Apply Differin Gel 3-5 days after each session
More on how to safely DIY scar revision treatments on my IG @101.skin or @drdavinlim
How is RFM or radio frequency microneedling different?
Think of this as supercharged microneedling. This treatment uses insulated needles that deliver controlled heating of 67 degrees for a fraction of a second. Insulation of the needles provides protection to the upper parts of the skin.
RFM is much better than microneedling because HEAT is required for optimal remodelling of collagen. Lasers, HIFU, RF &. RF microneedling are termed ‘energy devices’ as they provide heat energy to the dermal layers of skin.
Do I ever use microneedling & PRP?
I did from 2014 to early 2017. I do not routinely PRP as I think it adds very little to the procedure, perhaps a marginal improvement in recovery time.
If you really want this procedure, book a consultation with my clinical nurse. The can add PRP to your treatment if you really want it.
Personally, I would rather do things that work, namely dermal fillers & or autologous fat transfer to select cases.
What is the role of fat transfer for acne scars?
Much like fillers, fat can provide volume. All scar revision procedures are aimed at stimulating your immune system to regenerate tissue. If you can not ‘fill up’ the hole (atrophic scars), you may require a helping hand. That is where fat comes in handy.
Micro & mili fat transfer can replaced tissue (dermal collagen & adipose tissue), destroyed by acne. Nano fat can improve skin quality.
Fat transfer is not a new procedure, it is just that in the past this treatment is not as predictable as it is today.
There are many pros & cons of this procedure, briefly-
- Pros- natural source of filler. If uptake occurs, last longer. No allergy issues.
- Cons- takes longer to perform. Only some patients are good candidates, initially more costly, up take of fat is not as predictable as dermal fillers.
What is the role of stem cells in the management of acne scars?
Still undecided on this one, however the prospects look promising. Stem cell can be harvested from fat, as the concentration contains 500 times the convention of stems compared to bone marrow. The science sounds promising, however the main problem with fat is the unpredictability of absorption. New harvesting methods in 2021 – 2022 will be promising. I will keep you up to date in the Blog section.
When do I perform surgery for acne scars?
Surgery has a defined role in the treatment of acne scars this includes-
- Punch excision for very deep acne scars
- Subcision for tethered and anchored scars
- Excision for linear scars and bridging scars
- Surgical elevation for broad scars
Suitable scar types include ice pick scars, broad box car scars & bound down scarring. Surgical procedures are often combined with lasers & deep peels.
As per Medicare requirements, I perform all surgical procedures.
What is the role of RadioFrequency in the treatment of scars?
Radiofrequency or RF is an excellent treatment for early acne scars, & scarring associated with active acne. In the past I used eMatrix. Cutis still has this device, however I have replaced this with better equipment (eMatrix is over a decade old).
Tixel is a fractional energy device aimed at remodelling early & mild scars. Treatments take 10 minutes to perform, downtime ranges from 1 to 3 days.
Vascular laser using the latest Prima is best for red acne scars, whilst Pico lasers can improve brown scars or PIH.
RF can also improve established old acne scars, including rolling, box-car scars and atrophic scars. I have replaced eMatrix with RFM, also known as Genius – Infini RF microneedling.
Why does age matter?
Age matters because over time the structural support of the face decreases. As time goes by, your supporting fat pads diminish in size & volume, coupled with downward migration (heaviness & jowls).
What it means is that the supporting structures for the skin decrease with age. This is why it is important to treat both age related changes & acne scars.
Age related volume loss can only be reliably treated by one of two ways- facial dermal fillers or fat transfer. Lasers & energy devices do not replace facial volume.
If you have age related changes, it is vitally important to support your skin’s dermal layer. Fillers last 2 to 4 years. They are not permanent. I do not have a permanent solution to stop ageing. Fat transfer last longer.
Can I undertake scar treatments if I still have acne?
Yes, in fact this is the best time to undertake scar revision. Early acne scars remodel better than old acne scars. There has been a paradigm shift in managing acne scars as early as possible.
Fractional lasers, RFM & focal peels can be used for patients on Accutane- Roaccutane.
Who do I see for some advice on acne or acne scars?
If you have active acne, you should see a medical dermatologist at Clinic Cutis. Mild to moderate cases are managed by our clinical nurses & therapist. This is a good starting point if you are after non-drug treatments such as peels, LLEDs, phototherapy & good skin care advice.
Mild to moderate acne scars are treated by my team of nurses. They have had extensive training over many years in most of the techniques I employ- essentially everything I do, bar deep fully ablative lasers & surgery. Nurses are well versed in the use of deep focal TCA peels, as well as over a dozen lasers that are indicated for acne scars.
Book a free consolation with my nursing team for acne scar treatments. This avenue is suitable for patients on a budget, & or mild to moderate acne scars.
My work focuses on the management of severe scars (objective not subjective).
What is the cost of acne scar revision?
Acne scar revision is a highly complex procedure with many combinations.
Additionally the amount of sessions are variable, ranging from 1 to 5. This depends on the scar severity, your skin type, downtime & expectations.
A quote will be provided at the time of the consultation. In most cases, a Medicare rebate will apply (surgical procedures).
Another avenue to consult my nursing team. My procedural nurses are extensively trained in my field craft of revision. They are a good starting point for most patients with early & or mild to moderate scars. As a guide-
Fractional Fraxel – CO2 – Erbium – RF Microneedling: Starts from $490
V Beam Prima- Perfecta & Pico Lasers: Starts from $290
Microneedling +/- PRP: Starts from $290
Tixel Fractional Resurfacing: Starts from $290
TCA Paint/Cross: Ranges from $190 to $690
Combination treatments: Ranges from $490 to $1190
Medicare provides a partial rebate for scar revision on the face by a Specialist, however treatments such as Fraxel and Fractional resurfacing are NOT covered.
The above prices reflect what my nurses & clinical team charge.
Davin’s Viewpoint On Acne Scar Treatments
Acne scarring is one of the most common procedures I perform. My work is primarily aimed at sorting out severe scarring, however my team of nurses help me with mild to moderate scars.
How I differ is that most of my work is done by hand, with simple instruments like a brush & a cannula. I do however employ many lasers if the scars lend themselves to energy devices.
Most patients will have multiple scar types, including box car scars, ice pick scars, & rolling scars. Each subtype of scarring will have an optimal treatment. Not all scars respond to lasers- some scars such as ice pick scars respond nicely to TCA CROSS, whilst scars such as atrophic ones respond to filler & surgical subcsion.
An individually based method of scar removal will give the best outcomes- assessing scar type, skin type and downtime gives the balance that is needed. Patients must have realistic expectations. In some patients 90-95% improvement is possible, however in difficult cases, I can only achieve 70 to 85% global improvement.
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