A scar is defined as the fibrous tissue (collagen) that replaces normal tissue destroyed by injury or disease. This skin is different in color, thickness, and texture than the surrounding skin. Scars are visible signs left by a healed wound, sore, acne, burn, and some types of accidental injuries. Scars are very common in human beings’ lifestyle, 90% of the people have at least one on their body.
Causes of scars: Scar can result from accidents, burn, skin conditions such as acne, disease such as chickenpox, or from surgeries or due to rapid growth of body resulting in stretch marks and are a natural part of the body’s healing process. A scar results from the biologic process of wound repair in the skin and other tissues.
Types of scars
A scar is composed of collagen and a lack of elastic tissue. These are several different types of scars including:
A scar can be a fine line or a pitted hole, or an abnormal overgrowth of tissue.
Normal fine line scars: A minor wound like a cut will usually heal to leave a red, raised line, which will gradually get paler and flatten with time; which usually takes two years and appear as visible mark or line; in darker skin leave a brown or white mark.
Fine line scars are more common following surgery or linear cuts made over the forearm.
Discoloration or surface irregularity scars: These types of scars do not impair function or cause physical discomfort and include acne scars as well as scars resulting from minor injury and previous surgical incisions.
Hypertrophic scar: are thick clusters of scar tissue that develop directly at a wound site and do not go beyond the bounds of injury. They are often raised, red, and or uncomfortable and may become wider over time.
Keloid scar: are larger than a hypertrophic scar and extend beyond the edges of an original wound or trauma. Keloids can occur anywhere on the body, but they occur more commonly where there is little underlying fatty tissue such as the face (low part), neck, ears, chest, shoulders, upper arm. They are often associated with itching, pain, anxiety or depression, and disruption of daily activities.
Contractures are scars that restrict movement due to skin and underlying tissue (muscle and nerves) that pull together during healing. They are seen in patients who have burns and a large amount of tissue loss. Contractures usually form where a wound crosses a joint, restricting movement of the joint and called contractures.
Atrophic scarring (sunken scarring): This type of scar form when the skin is unable to regenerate tissue. These are caused when underlying structures supporting the skin, such as fat or muscle and collagen; are lost and appear as pitted scars. Atrophic scars are often associated with acne, chickenpox, bacterial infection, and insect or spider bites.
Stretch marks: Stretch marks are also a form of scarring. These are caused when the skin is stretched rapidly during puberty, pregnancy, or significant weight gain. This type of scar can improves in appearance after a few years.
Treatment of scars:
A number of treatments available to treat scar; most of them can be made to merge with surrounding skin to an extent of 30% to 95%, thanks to advanced technologies and treatments available to improve the appearance of almost any kind of scars. scar treatments depend on multiple factors, such as the nature, size, shape, and thickness of the scars; the location, age, genes, sex, and even ethnicity.
Fresh thin scars resulting from trauma or surgery can be treated with topical medicines like silicon/polysiloxane creams. It takes around 3-6 months to improve the appearance of the scar with regular applications
Acne scars can be treated with various procedures like chemical peeling, microdermabrasion, micro-needling, laser treatments using pulsed dye laser, fractional laser resurfacing lasers, pico laser, fractional MNRF, Enerjet, etc., Usually done at monthly intervals for at least 4-5 times, they stimulate collagen production in the deeper part of the skin making scars less visible. Most acne scars fall into atrophic or surface irregular scars.
All scars don’t need treatment, only cosmetically undesirable, unpleasant and physically, mentally disturbing scars are to be treated.
General Medication: Topical creams, ointments or gels, Silicone gels or sheets, and steroid injections and creams. Application of topical creams, a course of injection and silicone sheet dressings can shrink the fresh thin scars resulting from trauma or surgery. Hypertrophic scar and Keloid scar can be well managed by intralesional injection and silicone gel
Chemical peeling: Chemical peeling is a simple process of inducing a chemical solution in a controlled manner to remove the top layers. Chemical peeling requires multiple sessions in treating scars and best for surface layer scars; by exfoliating the dead superficial layers of the skin, which promotes the development of healthy new top layers of skin, making brighter and smoother. Chemical peels are most commonly used in treating acne and acne scars; include glycolic acid, salicylic acid, Jessner’s solution, resorcinol, and trichloroacetic acid (TCA).
TCA Cross is known as Chemical Reconstruction of skin scars mainly for pitted acne scars.
Cryotherapy: This treatment is mainly used to treat Keloids, liquid Nitrogen is applied on the scar to freeze keloid. In early stages, Cryotherapy can diminish their growth, for effective results may need to take more sessions at regular interval periods suggested by our dermatologists. And to enhance the results intralesional steroid injection is given.
Microdermabrasion: is a treatment procedure in which the skin is treated with the help of a special device that smoothes out the skin and improves tissue regeneration. This procedure is used to treat acne scars, fine lines, and skin discoloration. This treatment helps brighten the skin tone and reveal healthy skin.
Photon microneedle therapy:
Microneedling is a simple, cheap modality used commonly for treating acne scarring and for transdermal drug delivery. This treatment consists of a device with numerous needles with uniform length and diameter; which creates tiny punctures in the top layer of the skin and triggers the body to produce new collagen and elastin; resulting in improved texture and firmness by thickening of the epidermis and dermis of the skin.
Photon microneedle therapy combines conventional microneedle with the added benefit of LED light therapy and used to stimulate the biological activity of skin at a cellular level.
Platelet-rich plasma (PRP) is an exciting new method; involves separating the platelets from the whole blood. This concentrated platelet is injected into the scars (especially pitted acne scars) which is rich in growth factors, helps in collagen remodeling, and thereby improves the appearance of the scars. It is a safe and effective treatment as it involves the patient’s own blood. To enhance further results it is combined with fractional lasers.
Dermal fillers: Fillers injections are a temporary way to fill depressed scar(acne) using fillers such as Restylane or Perlane.
Surgical treatments or procedures: this includes
Subsicion: This is a minor surgical process used for treating deep rolling (acne) scars; it is performed to undermine the scar with a fine hypodermic needle. This breaks the fibrous strands in the affected area by separating the skin tissue from deeper scar tissue. This allows the blood to pool under the affected area, eventually causing the deep rolling scar to level off with the rest of the skin area.
RF subsicion is a modification of conventional technique where a blunt cannula is inserted below the scars and subsequently delivering the radiofrequency energy.
Dermabrasion: This process involves rotating electrical machine, the top layers of skin are removed till pinpoint bleeding occurs; as it mechanical minor skin resurfacing to remove surgical acne scars and done under local or general anesthesia. Dermabrasion, on the other hand, is a minimally invasive procedure for acne scar reduction
Scar revision is surgery to improve or reduce the appearance of scars and blends in with the surrounding skin. It also restores function and corrects skin changes disfigurement caused by injury or previous surgery or wound poor healing.
Punch excision/elevation: are usually done in ice pick and punch (boxcars) out acne scars. In the punch excision, the acne scar is surgically removed through a punch matching the size of the scar and the skin edges are sutured together. Punch excision is ideal for deep ice pick scars and narrow, deep scars. Punch elevation is utilized for depressed scars like chickenpox scars or boxcars.
Punch grafting: is a simple effective treatment done for depressed acne scars. In this process a small punch tool is used to punch a hole in the skin, removing the scar and replace it with a plug of new skin. The new plugged skin inserted into the area, are usually removed from behind the ear lobe. The grafts held in place with sutures or surgical glue.
Autologous Fat Transfer/Dermal Grafts as a natural filler for treating depressed scar and recently been used.
Laser treatment or Energy-based devices:
Nowadays, laser scar removal is one of the most popular and most demanded scar removing techniques, the reason being non-surgical, non-invasive technique, most effective results without any discomfort and downtime of surgery. This treatment uses high-energy beams to break hard scar tissues and remove the damaged and older skin tissue and rebuilds it with fresh, new collagen without harming the surrounding skin tissues and leaving behind less visible scars, most attractive and smoother skin.
Laser Scar Removal is the simple, easy, tolerable, and out-patient procedure with minimum downtime allowing you to continue your routine activities along with the treatment and deliver quick results. But like any other procedure, laser scar removal also has some side effects associated with it that every potential candidate should be aware of before committing to the procedure.
Fractional laser skin resurfacing: treats microscopic columns of skin. It is a non-invasive treatment that uses a device to deliver a laser beam that targets a fraction of the skin at a time. These are called microthermal treatment zones (MTZs). Within each MTZ old epidermal pigmented cells are expelled and the collagen in the dermis is penetrated causing a reaction that leads to collagen remodeling and new collagen formation. This evens out the depressions in the skin.
There plenty of fractional lasers resurfacing technologies, among them the few mentioned below are the most commonly used are:
Fractional Co2 laser produces a specific wavelength of light in the mid-infrared spectrum (10600 nm) and new versions have a super or ultra pulsed mode. It allows its laser energy is selectively absorbed by tissue water
Fractional Erbium YAG laser is a solid-state laser and emits the wavelength of 2940nm and its chromophore is water. This wavelength is closer to the peak spectrum of water and therefore has an absorption coefficient 12-16times higher than the CO2 laser. It is also a versatile laser and can be used in different modes such as ablative or non-ablative.
Fractional Erbium glass laser: Fractional Erbium glass is one of the most advanced lasers, used for skin resurfacing and rejuvenation. It is a non-invasive and non-ablative laser that works at 1550 nm wavelength.
A fractional non-ablative laser produces a gentler effect on the skin, keeps the epidermis intact, the laser energy heats the deeper dermis tissue in a controlled manner, and specifically activates fibroblast to stimulate neocollagenesis and dermal remodeling. This does not cause the water in the tissue to evaporate.
Fractional Micro-Skin resurfacing RF: [FSR]
This is also fractional skin resurfacing treatment done with the radiofrequency device and also called as fractional sublative RF. Hence it is not a laser, it can be used in a patient having laser phobia; for treating any atrophic or acne scar.
FSR produces volumetric heating into the deep dermis which helps in collagen remodeling & formation of new collagen beneath the scar tissue. As it is a Fractional process, it leaves the healthy skin in between the ablated area which allows faster healing with lesser downtime. FSR technology is useful in treating textural irregularities of the skin, wrinkles, and acne scars.
Fractional Microneedle RF: the microneedles are driven directly into the skin at a certain depth, and radiofrequency energy is then released; generating heat throughout the dermis. It results in volumetric tightening, collagen remodeling, and collagen production.
Fractional MNRF treatments are the latest innovations in the field of cosmetic dermatology. It is considered safer than fractional laser treatment and can be used on all types of skin without any major adverse effects.
Fractional MNRF delivers the energy deeper into the dermis; provides fractional ablation, creates microthermal zones, and leaves the healthy skin around, for rapid healing.
Fractional MNRF treatments are minimally invasive, minimum procedure time and downtime and the risks such as post-inflammatory hyperpigmentation and scarring are lower.
Pico laser: Pico Laser (or picosecond laser) is a laser device that uses very short pulse duration < 1 nanosecond which predominantly causes photoacoustic damage ( pulses of the light measured by changes in pressure ie sound waves)
The picosecond laser is mainly used for pigmentation removal, acne scars, skin rejuvenation and brightening, and tattoo removal.
Pico laser works creating laser-induced optical breakdown; which promotes collagen and elastin production. Pico laser can penetrate several layers into the skin. The laser energy once delivered causes tiny globules of air or bubble; and these bubbles are filled up with collagen forms deep within and raise indentations and depression caused by scars.
PDL: Pulsed dye laser are basically designed to rid patients of benign vascular lesions; they can also be used to treat scars especially red acne scars or fresh scars, hypertrophic, and keloid scars. The laser delivers an intense burst of yellow light to the skin; which is specifically absorbed by the blood vessels in the dermis. These blood vessels are coagulated and then reabsorbed by the body during the natural healing process; helps in collagen remodeling and hence scar correction.
Enerjet: Enerjet is synergetic innovation technology based on microtrauma and the effect of the healing compound. No needles, no risks of burns, no tissue necrosis. It is just safe with long-lasting results.
Enerjet uses Jet Volumetric Remodeling (JVR) technology – a high-pressure jet technology to laterally introduce healing agents deep into the dermal layer of the skin for a wide range of aesthetic indications. This single, innovative, non-thermal, and non-surgical solution is suitable for all skin types and all areas of the body. Enerjet is ideal for kinetic facelifts, scar repair, and dermal thickening. Enerjet solutions are proven to deliver superior, immediate, and long-lasting clinical results.
Advantages over lasers and surgery:
Safe, effective and simple
No thermal heating
Non-surgical, immediate results
Enerjet is used in both atrophic/depressed scars and in hypertrophic/ keloid scars and stretch marks.
How does Enerjet work?
A healing compound is administered deeply into the dermis using powerful jet technology. The healing compound, combined with kinetic energy, creates a controlled microtrauma, stimulating the body’s natural healing response. The jet disperses into the target zone to cover 100 times the area of a single 32G needle entry point, leaving virtually no signs on the skins outer layer (only 200 microns).
Enerjet in Acne scars: It uses pneumatic energy to first break up the tight scar tissue underneath the skin after which microdroplets of high molecular weight hyaluronic acid are delivered. The skin then responds to microtrauma by stimulating elastin and collagen production resulting in an improvement of the scars. The continued remodeling effects of the treatment improve the results over time
Depending on scar’s shape minor procedures are advised as mentioned above. The outcome is always better when we combine different modalities depending on the nature of the scar. No scar can ever be completely removed; always leaves a trace, but their visibility can be lessened by the above-mentioned means.
Acne is one of the most common and distressing skin problems in adolescents. There are raised bumps in the skin and some of them can be large and pus-filled. These are quite often painful. The affected areas are the face, chest, upper back, and arms.
Acne will resolve after a certain period of time but leaves behind scars. Do these scars go away? Some may look less conspicuous with time but most don’t fade away. Topical creams may not help much. However, there are procedures that will help reduce scars considerably and improve the texture of the skin over the face.
As with any disease, prevention is always better than cure. The best way to prevent scars would be to see a dermatologist as soon as you start developing acne. By preventing new pimples you are preventing scars. Also, I find that most with acne tend to pick on them or try to drain the pus from it. This will actually result in more inflammation. Squeezing a pimple can push the bacteria deeper resulting in more infection thereby more inflammation and ultimately more collagen damage and scarring.
Acne scars are formed after healing moderate and severe pimples. Abnormal healing and dermal inflammation create the scar.
Generally, acne should be treated in the early stage. If not, the acne gets infected and damage most of the skin. Severe acne after healing they leave a permanent scar that is visible from 10 meters distance.
Before treating the acne scar, it’s important to know the type of acne scar. Each type responds to treatment differently, Clear skin hair and laser center treats each and every scar with a different type of treatment and Laser technology.
Depending on the width, depth, and 3-dimensional architecture, Acne scars are classified into three basic types of Icepick scars, Boxcar scar, and Rolling scar
Icepick scar: These scars are deep scars with the narrow diameter and resembles large pores. Icepick scars look as it has been pierced by a sharp instrument and look like a small, thin and deep hole into the skin.
Boxcar scar: These scars are round to oval depressions with sharply demarcated vertical edges. They are wider than Icepick scars and give the skin an uneven pitted appearance.
Rolling scar: These scars look like wide depressions that typically have rounded edges and an irregular rolling appearance. Rolling scars differ from Boxcar scars in that they aren’t sharply defined and the skin itself looks uneven and craggy.
Acne scars treatment
There are many modalities that are used to treat scars effectively. The treatment has to be tailored to the individual patient based on the skin color, scar type, and the patient’s economic capacity. There are different types of acne scars which are atrophic scars (scars that are shallow), box scars (wide box-shaped), and ice pick scars (narrow and deep).
Acne scarring is a physical, emotional, and a permanent reminder of the uncomfortable skin condition. A number of treatments are available to reduce the appearance of scars.
We at Clear Skin Centre we are committed to providing our patients with best result-oriented treatments for acne scars. So if you are suffering from acne scars, there is nothing to worry about. We provide various acne scar treatments to get you acne-free skin and enhance your complexion. Our skin treatments will help you get rid of acne or pimple scars and have acne-free, clear skin.
Treatment options include Rejuvenation peels (Trichloroacetic Acid), surgical options(Subcision, Punch elevation, and excision, dermal grafts, autologous fat)
Procedures like( dermabrasion, microdermabrasion, and PRP) and Laser treatments (Enerjet, Scarlet MNRF, Endymed Pro FSR/MNRF, Fco2laser, Erbium Yag laser, Erbium glass laser, Intense pulse light, and Picolaser.