Chemical peels:

It uses glycolic acid peel, salicylic acid peel, pyruvic acid peel, TCA peels, deep phenol-based peels. Generally, chemical peels are done with subcision. Its best results are found with depressed/rolling/box scars. For ice pick scars, punch excision is done before chemical peeling. If there are superficial scars, that is less deep scars, then six to seven sessions of superficial peeling are required. Deep atrophic scars and ice pick scars usually require two to three sessions of deep peeling.

In the cross peel technique, a higher concentration of 80 to 100% TCA peel is applied with a specialized applicator only in the depressed scar area. Its 4 sessions are repeated every 15 days.

Let us also see what are superficial chemical peels.

The upper surface of the skin, that is, the epidermis is removed in a controlled manner, which is called exfoliation, due to which comedones are reduced and pimples, pigmentation, and scars are removed. After exfoliation skin regeneration starts and new collagen starts to form. Since superficial chemical peels are mildly potent, they may require repeated treatments.

Medium deep peels go to the deep layer of the skin, that is the papillary dermis, due to this the inflammation that occurs stimulates the skin to produce collagen in it. This helps a lot in filling the atrophic scar.

For pigmented acne scars we use combination peels such as salicylic acid, mandelic acid, kojic acid citric acid, retinol, and Jessner peel. Retinol peel is commonly known as the yellow peel.

Laser Treatment:

This category includes different types of lasers such as co2 laser, erbium laser, MNRF devices, plasma resurfacing devices. Co2 lasers include Fraxel laser, ultrapulse, smartxide, co2RE, and in Erbium lasers, Recosma, pixel, profractional, Lux 2940 are the standard brands.

IPL, PDL should be used for red acne scars. However, many doctors use the Nd-YAG laser for smaller atrophic scars. This will not give you much benefit. We at Arra Aesthetics use it to treat active acne and it gives great results.

KTP laser is used for redness and hypertrophic scars.

Surgical Treatments:

Punch or elliptical excision is preferred for ice pick scars and deep box scars less than 3.5 mm. Punch elevation is used if there is a depressed box scar more than 3.5 mm. In this, your scar is cut to the level of fat by biopsy punch and then stitches are done on the normal surface of the skin.

Subcision:

It is used for rolling or depressed scars. In this, after puncturing your acne scar from the side with the help of a needle, it is released from the fat.

Radiofrequency:

MNRF-monopolar, bipolar multipolar technology is widely used in dermatology. These devices use electric current for scar rejuvenation. They are only slightly safer than lasers but less effective. Because of this, if you are opting for MNRF treatment, then you have to take treatment sessions quite often.

Microneedling PRP therapy:

This is a new treatment in which a very fine needle is repeatedly punctured into the skin with the help of a machine. Injury to the dermal portion of the skin results in collagen repair and the scars become shallow. Combining it with PRP, the growth factors in PRP results in a much better healing response. It usually requires two to four sessions and the gap between the two treatments should be 2-3 months. Its results are much better than dermabrasion.

Fillers or fat grafting:

If we understand the pathology of atrophic acne scar, then it is important to see that tissue loss occurs due to inflammation. Due to this, depression is seen in the acne scar. If we fill this depression then the surface will become normal. If we talk about filler, then it is used in 2 ways, first, the loss of the component dermis of the skin is replaced. We use collagen filler or HA filler in this. The second objective is to replace the volume. It is needed in middle age or early old age. Many patients who have superficial acne scars at a young age notice that with aging, scars are more pronounced. This happens due to subcutaneous fat loss. For this, we use deep dermal filler or fat grafting. Fat grafting which we commonly use for antiaging treatment gives a rejuvenation effect to the skin due to stem cells along with replacing volume in deep acne scars.

You can decide which one to use in fat and fillers, after understanding its pros and cons during your consultation. Usually, fat or filler is combined with subcision. Personally, I prefer fat grafting because fat is a part of your body and lasts longer.

I generally do a combination of Recosma laser, microneedling, PRP, and chemical peels. Very few of my patients require subcision, fillers, fat grafting, or scar revision.

Acne scarring is unfortunate. After reading this blog I am sure if you are a patient of acne then you will get yourself treated in better ways so that you can prevent acne scars. If you already have acne scars, then you must have gotten the knowledge of different treatment options through this blog with the help of which you can have a better discussion with your dermatologist or plastic surgeon in your treatment selection. Ultimately, multiple treatment options for acne scars are planned while keeping in mind your treatment goal, your skin's tolerance, and your individual needs. If you are knowledgeable then surely your doctor will be of great help in this. Finally, your dermatologist or plastic surgeon and you should agree that the aim of treatment is improvement and not 100% cure. And remember if you choose any single treatment modality then expect the result according to the treatment.

Do not become a victim of wrong information and advertisement. You must read our upcoming blogs for the best laser for acne scar treatment i.e. Recosma laser treatment. In that, I will explain how Recosma laser is better than co2 laser or MNRF.