Yes. I use various types of lasers based upon the clinical features of your scar type & your ethnic skin colour. To understand what lasers are best, I will break it down into pigment lasers & resurfacing lasers. The former treats PIH while the latter improves contour changes from atrophy (divots, depressed scars).

Pigment lasers include pico lasers such as Picoway & Picosure. Settings matter, so not all providers will give you equal results. Laser is best combined with accurate skin care ingredients & sunscreen.

Resurfacing lasers can be useful in some cases of chickenpox scarring. My preferred laser is a small spot CO2 with a short pulse duration. These include eCO2, Mixto, CORE & Deka lasers. I do not recommend the Ultrapulse for pox scarring as the sequential delivery of beams is too close for pox scars. This will leave grids. 3-4 sessions are required over 4 to 8 months.

Non-ablative lasers in the 1927, 1440 to 1550 wavelength can be used. These are gentler compared to CO2 or erbium lasers. In most cases you will require at least double the sessions to gain the same amount of traction as ablative lasers.

Yes. Sensible DIY microneedling with a 0.2 to 0.25 mm device can help. Do not go deeper than this as scarring is a side effect of DIY needling. Obviously clinical microneedling goes much deeper.

Microneedling works by scar remodelling through collagen stimulation. Shallow needles stimulate cytokines & growth factors to activate fibroblasts. These cells lay down new collagen & can plump up depressed scars.

Deep microneedling denatures scar tissue & fibrosis. As a guide 4-8 sessions of microneedling is the norm. Microneedling will not free up extremely fibrotic scars, nor will they give good correction in long standing atrophic scars.

Understand this concept (the same applies to acne scarring), & you will get ‘scar revision.’ Dermatologists employ methods to assist your immune system to remodel & produce collagen. These treatments include lasers, microneedling, peels & energy devices. If your immune system cannot do this, we use fillers to replace loss collagen.

Fillers are designed to replace volume loss in the dermis or hypodermis. In some cases of scarring, the volume deficit is too great.

For resistant chickenpox scars use dermal fillers & limited subcision to insert hyaluronic acid in the lower dermis to replace collagen. Correction may be partial, or scars may be fully correct with fillers. It normally takes me 1-3 sessions to get a good result. 

We all would like a long lasting & permanent solution for everything from scars, hair loss, volume loss & wrinkles. Your choices are limited. Fillers can provide correction as hyaluronic acid acts as a spacer (to replace collagen loss due to inflammation).

All other procedures rely on your own immune system to regenerate collagen. This is dependent on individual factors such as age & genetics. If you are against fillers, you have several options to choose from including-

• Saline injections: 3-6 sessions over 6 months
• Dermal grafting: 2-4 sessions over 4 months
• Nanofat injections: 2-3 injections over 6 months
• PRP: 3-4 injections over 6 months

These injections are less predictable than dermal injections of hyaluronic acid – calcium hydroxyapatite.

Unlike dermal fillers (think putty or bog), collagen stimulating injectables recruit your immune system to produce collagen. The two main types employed to treat chickenpox scarring include Rejuran S, which is a polynucleotide or Profhilo, which is hyaluronic acid. In summary-

• 2-4 sessions required
• Takes more time to see results
• Fast recovery
• May last a lot longer than fillers
• Great safety profile

The level of scarring is directly proportional to the time it takes to commence treatment. The longer you leave it, the greater the chance of chickenpox scars. The number one way to reduce the severity of this viral infection is to take Valtrex or Acyclovir within 24 hours of developing the rash. Every single hour counts. See you GP.

Scarring occurs due to 2 factors. The infection itself (hence treating early will mitigate scars),  & scratching. Here are some helpful hints to reduce itching & scratching from chickenpox

• Antihistamines. Get the ones that bomb you out, phenergan or polaramine is a good option.
• Trim your nails really short. If possible, wear cotton gloves.
• Pat or slap your skin if you itch, don’t scratch (easier said than done)
• Have an oatmeal bath
• Use Calamine lotion on itchy spots
• Menthol + Sulphur + Calamine is a favourite amounts dermatologists
• Ice packs can help, sedation with tablets can stop you scratching

Your GP will look after you regarding the other effects of acute chickenpox including monitoring your respiratory function, coughing, eating etc.

Scars, including acne & chicken pox are best treated early as collagen remodelling can be enhanced with minimally invasive treatments including lasers, microneedling & even LED phototherapy.

If we catch the scars in a timely manner, we can, in most cases, prevent atrophic changes (contour changes). Pico lasers can address pigmentation changes as well as early collagen loss. Treating pox scars early means less downtime, less costs & better results.

Ethnic adults are most at risk for scarring. This is because chickenpox is more severe in adults. 

Darker skin types including Asians, Central & South American as well as Middle Eastern & Islander patients have a much higher rate of skin colour changes following chickenpox infection. This is known as post-inflammatory hyperpigmentation or PIH.

RF microneedling (RFM) incorporates heating with microneedles. Heat can be delivered through non-insulated needles (Secret RF, Scarlet, Instensif) or insulated needles (Infini, Genius RF). Heating generates more collagen remodelling as it activates proteins called HSP or heat shock protein. (This name says it all).

In the majority of cases, I do not normally use RFM for isolated chickenpox scars as the grid pattern of RFM is much larger than the scars themselves. High settings of RFM, especially on the forehead & temples can often leave grids. I do believe that RFM is useful for acne scarring (deep, rolling & atrophic scars), however in the context of chickenpox scars, I prefer small spot size lasers.

The histology of a varicella lesion is akin to an explosion in the epidermis & dermis. Big bang takes out collagen up high & low, leading to atrophy. The degree of inflammation is acute & extensive. This correlates with the clinical findings of chickenpox scars as they are –

• Wider than acne scars
• More focal than acne scars
• Have more focal dermal atrophy

In general, I find chicken pox scarring harder to treat than acne scars as in most cases, your immune system cannot generate enough collagen to correct the divot. In many cases I need to use dermal fillers.

Microdermabrasion can be effective in reducing the look of chickenpox scars. It works by improving the luminosity of skin, aiding in reflecting light. This reduces the perception of scars by reducing dull skin. It does not improve collagen production.

This simple cost-effective treatment can be performed with no downtime. Another treatment we use at Cutis is Hydrafacial. It works around the same principle as microdermabrasion.

No. The rebate only applies to select forms of objectively severe facial scarring from acne, burns, surgery & trauma.

Lasers including fractional, nano & pico lasers are not claimable through Medicare. Medicare favours the management of lighter skin types as there are item numbers for the management of red skin conditions including visible red veins at a distance of three meters.

For early intervention of chickenpox scars, book an appointment with my laser nurses. They are versed in the use of pico & fractional lasers.

For intermediate to late/advanced scarring, you are best off booking an appointment with my nursing team. They can guide you through the process of lasers. They offer a excellent scar revision service at an affordable price (often cheaper than GP-cosmetic physicians & other ‘cosmetic clinics’)

I can intervene with dermal fillers for complex scars or severe scarring. In most cases of chickenpox scarring Medicare does not give a rebate. In some cases of severe scarring (measured objectively, not subjectively), a rebate may apply depending on the modality used.

For Sydney patients; book a consultation with myself at our clinic in the Eastern Suburbs. I will be taking in select patients in early 2024.