Acne scars are one of the most common problems I treat as a plastic surgeon and unfortunately one of the most difficult to treat. There is a misconception in plastic surgery that scars can be permanently removed with plastic surgery. Scars cannot be removed but can be significantly improved.
Acne scars pose specific challenges because they are on the face, have a large surface area, and differ in their depth. A straightline scar, such as a tummy tuck or C section scar, is linear and can be improved by removing the scar and resewing the skin to make it thinner and more attractive. Acne scars have traditionally been treated with resurfacing technique which in effect "sand down" the skin to make it smoother. Historically this has been done with dermabrasion, chemical peels, or lasers. Even with aggressive technique, this approach has yielded mostly modest improvements.
In terms of resurfacing, repeat treatment seem to be more effective than a single aggressive treatment. Treatments repeated over time will cause the skin to repeatedly heal through a process known as collagen remodeling. As more and more new collagen is produced, the skin becomes rejuvenated and smoother.
Another key component of resurfacing is depth of penetration into the skin because the acne scars are so deep. Traditional ablative procedures which remove the entire skin surface are very aggressive and require prolonged healing time. However, because they are aggressive, they do not penetrate into the deeper layers of the skin. A typical fully ablative resurfacing procedure such as a CO2 laser, phenol chemical peel, or dermabrasion can only be done to a depth of about 300 microns which reaches only the superficial layer of the skin (papillary dermis). New technologies in lasers have utilized a concept called fractionation where the laser is broken down into tiny dots which penetrate the skin to a much deeper lever; up to 1200 microns. This technology works similar to a television screen where tiny pixilated dots make up a picture when viewed from a distance. In additon to going deeper, fractionated technology has the additional advantage of quicker healing times making repeat treatments more feasible.
Microneedling borrows from the concept of fractionation using small needles delivered with a hand held pen like device (Dermapen) to penetrate the skin up to 2.5mm. Microneedling has several advantages over fractionated lasers; less expensive, office based, rapid healing, and safety in all skin types. Microneedling can be repeated to a desired endpoint with a much lower cost point than more expensive fractionated laser therapy.
For best results, microneedling is combined with a growth factor type skin care regimine to maximize collagen production and efficient healing. The skin care line, Regenica, is uinque in it's focus on growth factor model of skin care making it an ideal product to be used with microneedling.
Treating the acne scars on the outside with resurfacing and skin care can give good results but the deeper layers and ignored. For this reason, treating an acne scar from the top (resurfacing) and the bottom makes sense and delivers better results. Fillers have long been used to treat acne scars but have been associated with short duration of effectiveness as they are degraded by the body. However, one filler has gained FDA approval to treat acne scars and has also been approved for 5 years. Bellafill is the only filer approved by the FDA for the treatment of acne scars. It combines the smoothness of collagen with PMMA microspheres to stimulate the body to produce new collagen to replace the Bellafill when it is degraded. The body will continue to produce collagen in response to the PMMA microspheres for up to 5 years.
Bellafill acts by stimulating new collage and pushing the acne scars up and making them flat. Combined with microneedling and the right skin care; the combination of Bellafill and microneedling offers the most advance method of improving acne scars.