SCAR REVISION

How can acne scars be managed?
Several graded steps can be taken to manage acne scars. First, rejuvenating creams can be utilized. These products which contain tretinoin (Retin-A, Renova, Differin, Tazorac), can improve shallow defects over a period of time. They also help to control the formation of new acne lesions. Additionally, AHAs (glycolic acid, lactic acid) contribute to overall improvement in skin texture. Over-the-counter "cosmeceuticals" ( Skinsiderations ) also aid in this chemical rejuvenation process.

Second, chemical peels can be utilized for superficial and deeper resurfacing. A variety of chemical peeling agents can be used and vary according to the depth at which they penetrate the skin.

Third, a procedure called subcision can greatly reduce certain types of acne scarring. Subcision is a unique form of incisionless local undermining. This method of cutting under a depressed scar using a hypodermic needle, attempts to raise the base of the defect to the level of the surrounding skin surface. The effectiveness of this procedure depends on three distinct phenomena: (1) the act of surgically releasing the skin from its attachment to deeper tissues results in skin elevation. (2) the introduction of a controlled trauma initiates wound healing with formation of connective tissue which augments the depressed site. (3) a pressure dressing helps to flatten the defect. The disadvantage of subscision is bruising. The advantages are long-lasting scar correction with little down time and cost. It also can be repeated if needed.

Finally, laser resurfacing, which is the most aggressive treatment, can be utilized. This is done with an Erbium or CO2 laser and produces a controlled burn that penetrates the second layer of skin. The drawback to this type of treatment is greater "down-time". It takes two weeks for crusting and oozing to resolve and redness may persist for several months.