Acne Scar Management - Dr. KWAN Kin Hung, Vincent

Q1. Only I have acne scars? Why?
Acne scars may occur if you miss the “golden period” for acne treatment. Try to use topical or oral medications as soon as acnes develop. If you delay treatment or squeeze acnes frequently, the resulting

It is more difficult to treat acne scars than to treat acnes, and the treatment outcome may not be satisfactory. To prevent acne scars, seek medical attention as soon as acnes occur.

Q2. Is there only 1 type of acne scar?
There are 3 types of acne scars: acne marks, depressed scars and raised scars. Acne marks are just flat discolorations, not scars. They may be red or brown in color.

Red marks are caused by dilated blood vessels due to skin inflammation, while the brown ones have to do with damage to melanocyte by inflammation, which results in post-inflammatory hyperpigmentation.

Treatment is not necessary for acne marks. With proper skin care, sun protection, if there is no new acne formation, acne marks will fade on their own.

Raised scars are either hypertrophic scars or keloids. Depressed scars are atrophic scars. There are 3 types of depressed scars: boxcar, ice pick and rolling scars. In terms of treatment, ice pick scars are more difficult to treat. 

Q3. What can I do with all the dense, uneven acne scars?
Dense, uneven acne scars can be frustrating. They can be treated by fractional CO2 laser. It uses clusters of laser beam to cause dense, tiny abrasions in dermis, thereby destroying and removing the scar tissues. It can also stimulate collagen reconstitution to fill the depressions. The face may get swollen and red for 5 to 7 days after treatment. Treatment is conducted every 6 to 8 weeks. Outcome is visible after 3 to 4 sessions.

For less dense rolling scars, non-ablative fractional laser or Pico Laser is the treatment option. They can promote collagen reconstitution to fill the depressions.

The recovery period is shorter than that of fractional CO2 laser.

Q4. My face has a few acne spots. They look OK but are hard to hide with makeup. What can I do?
To improve individual atrophic scars, treatment options include scar excision and suturing, subcision, e.g. subcision with fat graft or hyaluronic acid augmentation.

Laser resurfacing can be used to enhance the result when necessary. The overall outcome is satisfactory.

Q5. Is there a pain-free, quick-recovery treatment for acne scars?
All acne scar treatments are effective only if the treatments are at the dermis. Any treatment at the dermis will inevitably lead to discomfort, and it takes time to recover. The discomfort during treatment can be relieved with topical and oral medications.

The usual recovery time is around 4 to 7 days. If the recovery time is too short, it means the treatment has limited stimulation on the skin, and less satisfactory outcome is expected.

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