The Truth About Acne Scarring
In this article you'll learn:
1. What an acne scar is.
2. Why you should ignore Bio-oil acne scar treatment.
3. How retinol can help — but not with all scars.
4. The differences between fraxel laser, microneedling, subcision and filler.
5. Why Vitamin E can't do what many brands say it does for acne scarring.
With zoom calls more prevalent, acne scar fading is a growing area of interest. But there are many misconceptions out there about treatments, especially over the counter.
Treatment is not for everyone. Some people can live with acne scars, while others feel that the scars affect their everyday life.
Let’s expose some truths about acne scarring, with help from Dr. Steve.
1. What is an acne scar?
A scar is a collection of abnormal bundles of collagen formation in the dermis of the skin.
Dr. Steve says: So, essentially, scars are bad collagen — it's not organized correctly, it's either a little bit hypertrophic (a raised scar) or opposite, a little atrophic (indented scar).
2. Acne scarring means you should see a derm
Dr. Steve says: I'm more aggressive with acne treatment when I see some evidence of scarring. If I see some pockmarks, icepick scars or boxcar scars, then I know that this person is getting some real long term skin damage from acne and they need some extra help. Based on what a scar looks like — how deep the wound, how wide it is, how severe the insult is, that’ll determine treatment.
3. Why acne scar treatment creams like Bio-Oil are not a good solution
Retinol helps collagen renewal and therefore helps with acne scarring, so why don't scar treatment creams use retinol?
Dr. Steve says: “Some scarring is very deep — the icepick or boxcar scars, no cream is really going to make a difference there. Things like Bio-Oil or Derma, silicone gel sheeting, the evidence is not very strong that they make a big difference.”
Dr. Steve allows that there is some evidence for silicone gel sheeting for scars, which hydrates the scar, makes it a little bit softer and improves the color. “But the studies are not that well done on these creams, especially for the thicker scars,” he said.
4. Retinol is good for collagen renewal — and more.
With scarring that is much more superficial — small indentations, surface roughness, dyspigmentation, retinoids can work.
Dr. Steve says: Retinol, the main ingredient in our Night Cream, modulates collagen synthesis to help stimulate the right kind of collagen production. This helps with smoothing the skin on very superficial scars. As a result, you get less indentation and you promote healing.
“But Retinol also does other things. It helps balance the skin pigmentation as it affects melanocytes, so you get fewer prominent dark spots.”
5. Deeper acne scarring requires more aggressive treatments, like fraxel laser.
Dermatologists often recommend treatment when someone answers “yes” to one or more of the following questions:
- Do I often wish that I could get rid of my acne scars?
- Do I feel that my scars limit my opportunities to date, get a job, advance my career, or perform well in school?
- Am I less social now than before I had acne scars?
For some guys with deeper icepick and boxcar scars, fraxel laser treatment is an option.
What it is: Fraxel laser is a carbon dioxide laser that vaporizes the skin and creates micro channels across a sort of lattice structure, little bladed pieces of skin across your face.
Dr. Steve says: “You're essentially creating a controlled groove, and when you create a controlled groove, the body then heals,” said Dr. Steve.
6. The difference between fraxel laser treatment and microneedling
What is microneedling: Similar to fraxel laser, it uses carbon dioxide to create a vaporized skin microchannel that leads to healing. “You create these little holes via a stainless steel needle, and you apply that across the face, and that stimulates healing,” said Dr. Steve.
Dr. Steve says: “Microneedling is a lot cheaper. Fractal laser treatment requires $100,000 pieces of equipment, whereas microneedles are probably a couple hundred dollars, it's just a little tool. You can even do it at home, but I recommend seeing a dermatologist, obviously.”
7. What's the deal with filler?
What it is: Dermal fillers are injected into the skin to raise depressed areas of acne scars or stimulate the skin’s natural production of collagen. Material used for filler can include silicone, hydrogel or sometimes they can take fat from your body — depends on what your dermatologist wants to do.
Dr. Steve says: “I think filler is a good tool for those bigger scars that are indented, so you can fill it and it props up the skin.”
8. Subcision, what is it?
What it is: It involves inserting a small needle into your skin to release the acne scar from the underlying tissue. This allows your skin to rise and to diminish the appearance of the acne scar.
Dr. Steve says: “For a boxcar scar, it basically props up the skin. So imagine having scars that pull down the skin a little bit, just kind of cutting those in and then allowing that to fill in normally.”
9. Acne scarring can be permanent
Dr Steve says: “I tell my guys that scarring is definitionally permanent. There are many ways that we can improve the look, the color and feel, and manage expectations, but sometimes it's impossible to get someone back to a completely normal skin tone and color.
“You can't completely eliminate a scar, even if the result looks perfect. Scars are always going to be there. I have some guys where I can just see right off the bat that they’re gonna respond really well to Fraxel, while some guys have such severe scarring that I tell them we can make it look better, but you're not gonna return to the natural skin tone or texture.”
10. Vitamin E won’t fade acne scars
Dr. Steve says: “There are some papers that say vitamin E can help with acne scarring, but the evidence is really weak. There are a lot of things that are being promoted as scar treatments, almost none of them have very good data. The best one is probably silicone gel sheeting, little strips of silicone you get in any drugstore. That probably has the best evidence, certainly better evidence than vitamin E."
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