Dermal Grafting Acne Scars

Dermal Grafts for Acne Scars At A Glance

  • Best Results3-8 sessions (outdated)
  • Treatment Recovery4-6 days
  • Procedure Time30-80 min
  • Skin SpecialistNot performed as treatment outdated
  • Duration of ResultsLife
  • AnaestheticBlocks
  • Back to Work2-6 days
  • Cost$$ Partial Medicare rebate in most cases

Dermal Grafting Acne Scars

Dermal grafting involves harvesting of autologous collagen. This collagen or dermal graft is then placed in atrophic acne scars. This procedure can be used for isolated scars with low volume deficits. This procedure has now been largely replaced with fat & stem cell transfer & collagen stimulating dermal fillers.

FactsFacts on Dermal Grafts For Acne Scars

  • This is a form of autologous collagen transfer
  • In theory it also transfers stems & fibroblasts to atrophic scars
  • The donor site is the back of the ear
  • Each scar is incised down to the fat layer
  • Tiny fragments of collagen is then inserted
  • Laser resurfacing months after can reduce scar lines formed by incisions
  • I reserve this procedure for isolated liner scars only
  • Dermal fillers, adipose stem cells & autologous fat transfer has largely replaced dermal grafting

What is dermal grafting?

This procedure is over two decades old. Newer techniques such as dermal smashing have been recently described. There are many spins on this technique, including autologous cell transfer & stem cell therapy & transplantation. Dermal grafting is essentially removing dermis from one part, processing the matrix, then re-implanting it in atrophic scars, including acne & chicken pox scarring.

Dr Rob Sinclair in Brisbane is probably one of the most experienced surgeons in the field of dermal grafting. I was fortunate enough to be taught by him.

How is this procedure performed?

The procedure is divided into harvesting, recipient site preparation & graft insertion.

Harvesting is from behind the ear. CO2 laser is used to destroy the upper part of skin, known as the epidermis. This donor is excised, and the site sutured. The donor is chopped up (literally) into many fragments.

Scar site preparation: A tiny nick is made aligned at the 3 to 9 oclock orientation, it is often elliptical in design. A pocket is made down to the fat layer.

Graft insertion: tiny fragments of dermis is placed into the atrophic scar, & sutured with a 6’0 nylon suture. Each and every atrophic scar is treated with this similar procedure.

After correction (usually 3-24 months after the journey began), the areas are resurfaced with either CO2 or erbium ablative lasers. This decreases the visibility of scar lines caused by insertion.

How many sessions will it take to treat my acne scars?

Grafting has limits, especially in the context of large volume deficits – namely highly atrophic acne scars. In this context, it may not be practical or feasible to correct. The number of sessions required is based upon adding up ALL the volume deficits. This ranges from one session (for mild atrophic scar) to over 40 sessions for multiple scars.

What are the limitations of dermal grafting?

Dermal grafting is limited by both dermal donor sites & practically of treatment when it comes to extensive scarring.

The classic donor site is postauricular or behind the ear. The total area is about 4 by 1 cm by two. Or about 8-10 cm2. Preauricular donor sites are less preferred due to the scar line, however if required, this is another option.

The practical aspect of say 200 to 400 individual atrophic scars are limited by time constraints. If 10 scars are treated per session, 30-40 sessions may be required. The greatest rate limiting factor is volumetric deficits. Some scars have deficits of over 3-4 mls (that is per scar). This is where autologous fat transfer has some merit.

Davin’s viewpoint on dermal grafting & acne scars

I was fortunate enough to have gone through the process of dermal grafting two decades ago. Prior to the rise of dermal fillers, this was probably one of the only methods to correct atrophic scars. Fat transfer at that stage of the game gave dismal results with very high reabsorption rates.

Grafting is still useful for isolated scars, especially atophic linear scarring where stip harvesting can give good correction. I have largely replaced large volume correction with either collagen stimulating fillers (PLLA – Ca OH) or ASC – fat transfer.

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