About Acne Scarring
I divide acne scarring to 2 types. Superficial or Deep type.
I would recommend Medi-peels regularly at 2 to 4 weeks interval to lighten and reduce superficial discoloured type of acne scarring. I would also recommend Q-Switched Laser at 2 to 4 weeks interval for superficial brown/ black discoloured acne marks reduction. These patients usually may have concomitant active acne which can be treated at the same time. These treatment have no downtime and you can put on make up after the treatment. Take home products for daily use may also be useful for adjunct treatment.
It is not easy to treat deep dented/pitted/ rolling acne or chickenpox scarring. These cases may never go back to “original” baby smooth skin. For deep acne scarring, I would recommend multiple sessions of pixelated carbon dioxide Laser treatment for reduction of scarring. This involves downtime and is painful. I would recommend a thick layer of numbing cream for at least half an hour beforehand and a cooling liquid nitrogen cooling spray during the treatment for added comfort. Your skin will be red for 3 days and the black pixels will take about 1 week to drop off. The skin will start to improve a few weeks after treatment. In fact some patients report even more further improvements after few months as the skin continue to remodel. I would recommend taking leave and avoiding social events after the treatment for a week. These treatments should be done perhaps between 1 to 3 months apart as necessary.
Acne Scarring Treatment
There are 4 major causes for Acne. As such, my treatment for Acne usually would involve a Combination of treatments modality to cover the different aspects of Acne causation. I strongly believe effective Acne Treatment has be by Combination Therapy.
In tailoring the treatment for my patients, I would like to assess the severity as well as the suitablility and concerns the Patient may have. It may involve just external products and chemical peels. It may also involve oral medications, Laser and even injections.
I usually would recommend a acne bacteria killing facial wash as well as exfoliants containing lotions for daily use for unclogging. I also do prescribe creams and gels that contain anti-microbials medication that kills bacteria. Main stay in-clinic treatment would be regular Medi-peel, using superior grade glycolic acid with or without salicylic acid.
For more severe Acne, I would recommend oral medications including Antibiotics as well as Isotretinoin. As with all medications, oral medications do have some side effects. I will discuss this individually with the patient explaining the various side-effects and possible measures to minimise them. I would also need to follow up and moniter the effects and adjust the dosages accordingly, as well as monitoring the side-effects.The decision is always a joint one. I do not believe in the old school style where the doctor would ram down the patient`s throat whatever treatment he had prescribed, because from my experience, patients would not follow the treatment regime then anyways!
Laser has a role in certain Acne cases if the patient is hairy and would like to reduce facial hair as the same time. It also has a bacteria killing effect directly.
I would also recommend Intra-lesional steroid injections for severe cystic nodular acne (yes, injection into the big acne lump on the face!). This would help shrink the lump faster. This is especially useful for emergencies. I have “saved” many a brides` wedding this way over the years! However the side effect is that sometimes (not always), it causes the skin to over-shrink and it becomes a “dent” which may takes many months to grow back.