Those of us who have battled acne at some point in time would also most certainly have been bothered by the resulting scarring. While most commonly attempt to smooth out the scars by over-zealously using facial scrubs, going for frequent facials, or even applying various peels and acids, but to no avail.
We ask dermatologist Dr Teo Wan Lin, founder and medical director of TWL Specialist Skin & Laser Centre, for her expert recommendations and tips on how to effectively treat and heal the different types of acne scarring.
Dr Teo is the founder and medical director of TWL Specialist Skin & Laser Centre. She is a Ministry of Health accredited dermatologist, specialising in both medical and cosmetic dermatology and has also developed her own dermatologist-grade cosmeceuticals – Dr.TWL Dermaceuticals.
For people who suffer from uneven skin texture and skin scars, what is the best way to smooth out skin’s surface texture for good?
The best way to smoothen skin texture is to first diagnose the type of scarring and the cause of it. Post acne scarring can occur in the form of post inflammation hyperpigmentation as well as deeper scars which are known as ice pick and box car type of scars that go down to the level of the dermis.
Ice pick and box car scars are best treated with fractional CO2 lasers, which break up scar tissue and help to injure the skin in a controlled fashion to stimulate the underlying dermis to regenerate and to fill up the holes in the skin.
In my practice, we use this in conjunction with other treatments such as topicals like tretinoin which is a prescription product that stimulates collagen formation in the skin, together with cosmeceuticals like stabilized vitamin C as well as an intensely concentrated hyaluronic acid serum that work synergistically with laser treatments to help skin to regenerate and heal.
It is also possible to combine the fractional CO2 lasers with chemical peels, so I use a combination of glycolic, lactic and salicylic acid peels, which help to stimulate the epidermis and the dermis to heal better.
Dr. TWL Vita C Gold Serum and Hyaluronic Acid, sold as a set at $251.45, available from drtwlderma.com.
Will exfoliating at home help scarring at all?
Exfoliation scrubs will not help depressed scars as they merely affect the top layer of skin. Also, exfoliation is not necessary from a dermatologist’s point of view. On the contrary, when one is trying to regulate the rate at which skin cells are being shed, chemical peels and the use of a topical retinoid like tretinoin are much more effective. When one grows older, a common complaint is that skin looks dull because the skin cell turnover rate slows down. Chemical peels and topical retinoids help to increase the cell turnover rate to improve skin radiance.
Is laser resurfacing a permanent solution? Will pitted scars recur?
The CO2 laser otherwise known as fractional resurfacing, is considered a permanent form of scar treatment. However, the success of the treatment firstly depends on the severity of scarring, followed by the age of the patient - so younger patients tend to respond better than older patients who are also battling aging.
It is also critical to ensure that the underlying cause of the scars is first treated. So if the patient still has active acne going on, it is not recommended to do fractional laser resurfacing, because this will aggravate the acne and the new acne bumps will often leave new scars and from that perspective, the resurfaced areas of skin will need to be treated again when new scarring occurs. Conversely, in someone whose acne has already resolved and fractional resurfacing is done by a trained professional, the pitted scars tend not to recur unless there is a new skin condition.
What is the best course of action to heal scarring holistically?
First of all, get your underlying problem diagnosed. If you are an adult and you still suffer from on and off breakouts. It is essential that you get your acne treated first. Once you get proper medical treatment, also get your scars diagnosed. If you suffer from deeper types of scars such as dermal scars, ice pick and box car scars, then it is wise to consider fractional resurfacing in combination with other treatments as recommended by your dermatologist to attain a satisfactory result.
Can a person who has this problem expect to have baby smooth skin forever, if they follow the treatment steps consistently?
For someone who has pitted scars and uneven skin texture, it is definitely possible to have an improvement in skin texture and overall appearance, if you get your skin condition properly diagnosed and treated by a dermatologist. However, the level of improvement would depend on compliance to the recommended treatment program.
Furthermore, it is critical that patients understand the importance of applying cosmeceuticals and retinoids as complimentary treatments, because lasers themselves have certain inherent risks, so one is not able to constantly do it at close intervals.
Fractional CO2 lasers, for example, should not be done more frequently than once a month due to the long downtime as well as the potential to cause serious side effects such as post inflammatory hyperpigmentation. However, if you have severe acne scarring, it may be necessary to have a targeted series of three consecutive CO2 laser sessions, spaced a month apart, followed by maintenance with laser toning or chemical peels which have less downtime.
In terms of the application of cosmeceutical products, it is recommended that one applies that daily when undergoing treatments, as it can enhance the results of each treatment, and also help in the maintenance.