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Greater than 80% of the population encounters acne lesions at some time of their lives, although fewer than 20% develop serious chronic acne scarring. What are the factors that result in chronic acne scarring? Skin type and previous history of scarring do not seem to make a difference in who develops atrophic (acne) scars. These scars can also result from cystic acne, pustular acne, nodular acne and papular acne. First, acne scarring is really an ATROPHIC scar, a scar which actually lacks collagen. It is a "bound down scar", which has deep fibrous attachment to the underling tissue below the skin. The greatest predictor of acne scarring is a DELAY of three years or greater in seeking medical TREATMENT of acne. Thus, routine medical care of acne is the greatest predictor of lack of significant clinical scarring. Other factors include genetic predisposition and clinical predisposition to scarring. The question posed continuously of our company is "Can your products improve on acne scarring?" The answer clearly is "Yes," but how? Treatment with topical antibiotics (our Cleocin Pads and Metronidazole gel), topical exfoliants like tretinoin (Retin A® ) , tazarotene ( Tazorac® ), azeleic acid (Azelex®) , and the combined use of medical grade cleansers, toners for pH balance, and glycolics can result in such great improvement in ones acne that scarring is prevented. For severe disfiguring cystic acne, Accutane® may be the only solution. Products themselves cannot resolve already fully formed acne scars, however the correct skin preparation with products prior to certain skin treatments and surgical modalities can prepare the skin for optimal results from these procedures. Acne scars are generally classified by their structure: ice pick (deep holes), box car (craters) and rolling scars (broad surface irregularities due to sub dermal fibrosis and "pulling down" of the atrophic skin surface. Treatment Modalities for Acne Scarring Subcision, using a very tiny cutting needle placed under the scar, is a technique used to free up the fibrous adhesions resulting in traction on the scar. This simple office based procedure is often used to free up the "tethering " fibrous adhesions prior to combining this procedure with collagen injection for "plumping," or laser resurfacing for recontouring the scarred area. Carbon Dioxide laser facial resurfacing may result in clinical improvement of acne scarring from 25% to 80% depending on the degree of scarring. Dermabrasion of the face in an operative setting is very effective in improving acne scarring, however must be performed by a very skilled operator. Permanent hypopigmentation, infection and scarring may result without proper care postoperatively. Microdermabrasion, the use of sodium bicarbonate superficial epidermal resurfacing may be effective in the properly prepared patient to alleviate superficial acne scarring. At GreatSkin ® we have achieved significant success in treating acne scarring when the patient is well prepared with tretinoin, hydroquinone, topical Vitamin C and Epidermal Growth factor. Treatment of Cheloid scarring Unfortunately the physiology of cheloid scarring is totally the opposite of acne scarring, being hypertrophic with too much collagen proliferation as opposed to atrophic. A genetic propensity with certain skin characteristics leads to cheloid scarring, especially prominent along tension lines of the skin (chest, back and shoulders). Cheloid scarring is best treated with intralesional steroid injections, combined with application of silicone gel sheeting. Certain lasers such as the pulsed dye laser have shown some promise in treating cheloid scarring, but the condition still remains poorly responsive to most therapies.
Are you planning on having facial surgery? We have put together two excellent kits for our Pre and Postop clients. Read about both of these programs -- plus the protocols that Dr. Van Wormer uses to prevent scarring, bleeding and swelling when he does laser resurfacing.
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