Lightening agents (azelaic acid, kojic acid, and hydroquinone) and retinoids (tretinoin and retinol) can be used at home to treat the ruddy, brown discoloration related to acne scarring.
Salicylic acid treats not only the ruddy, brown discoloration associated with PIH, but also penetrates into the oil glands to treat active acne and to prevent new acne from forming. Trichloroacetic acid (TCA) can also be administered carefully in high concentrations to treat individual icepick scars.
This technique involves inserting a needle with a tiny blade at the end of it into areas of depressed acne scars to release the underlying scar tissue from “tethering down” boxcar and rolling acne scars. Subscission is often performed during the same session as microneedling, radiofrequency + microneedling, and/or fractionated CO2 laser to achieve optimal improvement.
Microneedling and Radiofrequency Microneedling:
Microneedling causes “controlled wounding” of the skin. This involves using thin needles to mechanically remodel the skin, stimulating increased production of hyaluronic acid, collagen and elastin. The final effect is improved texture and tone of the skin with an overall decrease in pore size. Adding radiofrequency to microneedling amplifies production and remodeling of collagen and elastin, which results in even more skin tightening.
Lasers and Light Treatments:
- Intense Pulsed Light (IPL or photofacial): this device delivers multiple wavelengths of light to target both browns and reds in the skin. Dr. Kiripolsky uses the M22 IPL, which is the most powerful, effective IPL on the market. There is no downtime related to this treatment and only minimal discomfort is experienced during the procedure. IPL not only evens out discoloration of the skin, but, also induces some increased collagen production, thus tightening the skin.
- CO2 laser resurfacing: this procedure creates tiny, microcolumns of destruction in the skin. The surrounding areas of spared skin are stimulated to fill in the columns, ultimately yielding fresh, healthier skin. The CO2 laser is ablative, meaning it selectively removes and resurfaces portions of the skin. It is the “gold-standard” for treating moderate to severe acne scarring and typically involves approximately a week of downtime.
Small droplets of strategically-injected filler can be used to raise depressed acne scars.
Thickened, hard acne scars are referred to hypertrophic scars and keloids. These are best treated by focal injections of steroids and/or 5-fluoruracil. Injection therapy softens and flattens out these thicker acne scars.
This technique involves using a circular blade to remove icepick scars (tiny, but deep scars) that are often resistant to other treatments. After the depressed scar is popped out, a tiny stitch is placed in the area and is subsequently removed after a week.