Acne ScarsI recently finished pouring through the last 2 years of acne scar research and have updated the scars page. It’s an evolving field. Here’s what I found:

Lasers are becoming more and more the go-to treatment for acne scarring. Fractional lasers, which treat only a fraction of the skin at once, are also becoming more popular for their ability to reduce side effects while still producing results.

Scientists are incorporating radiofrequency devices along with lasers and data is promising, while not earthshattering, that radiofrequency could help a bit.

Scar revision specialists have treated scars with fat injections for years with lots of success. However, recently, they are trying what they call autologous fibroblasts, which are cultured connective tissue cells from the person’s own body. This is also showing lots of promise.

Despite the advances, a person embarking on scar revision should not expect miracles, but should instead expect improvement. As always, data is showing that a combination of treatments (i.e. laser combined with subcision and augmentation) produces the best outcomes especially in more severe scarring. According to an article in the journal Dermatologic Surgery, “Severe grades of scarring often require a combination of filling agents for volume deficit, injectable agents for hypertrophic disease, neurotoxins to effect movement, and fractionated and ablative resurfacing for surface changes.”

Lastly, there appears to be vast confusion amongst dermatologists in the classification of acne scars. This highlights the need to carefully select a scar revision expert who is dedicated to and experienced in this specific area of surgery. If you decide to embark upon acne scar revision, do your homework and make sure you go with someone who specializes in acne scars.

Helpful links:
Acne.org Scar Forum: join in the discussion
Acne.org Scar Gallery: share your pictures

References:

  • Leheta TM, Abdel Hay RM, El Garem YF. “Deep peeling using phenol versus percutaneous collagen induction combined with trichloroacetic acid 20% in atrophic post-acne scars; a randomized controlled trial.” The Journal of Dermatologic Treatment. 2014; 25(2): 130-6.
  • Nirmal B, et al. “Efficacy and safety of Erbium-doped Yttrium Aluminium Garnet fractional resurfacing laser for treatment of facial acne scars.” Indian Journal of Dermatology. 2013; 79(2): 193-8.
  • Al-Dhalimi MA, Arnoos AA. “Subcision for treatment of rolling acne scars in Iraqi patients: a clinical study.” Journal of Cosmetic Dermatology. 2012; 11(2): 144-50.
  • Manuskiatti W, et al. “Comparison of fractional erbium-doped yttrium aluminum garnet and carbon dioxide lasers in resurfacing of atrophic acne scars in Asians.” Dermatologic Surgery. 2013; 39(1 Pt 1): 111-20.
  • Sardana K, et al. “Histological validity and clinical evidence for use of fractional lasers for acne scars.” Journal of Cutaneous and Aesthetic Surgery. 2012; 5(2): 75-90.
  • Bencini PL, et al. “Nonablative fractional photothermolysis for acne scars: clinical and in vivo microscopic documentation of treatment efficacy.” Dermatologic Therapy. 2012; 25(5): 463-7.
  • Maluki AH, Mohammad FH. “Treatment of atrophic facial scars of acne vulgaris by Q-Switched Nd:YAG (Neodymium: Yttrium-Aluminum-Garnet) laser 1064 nm wavelength.” Journal of Cosmetic and Laser Therapy. 2012; 14(5): 224-33.
  • Hedelund L, et al. “Fractional CO2 laser resurfacing for atrophic acne scars: a randomized controlled trial with blinded response evaluation.” Lasers in Surgery and Medicine. 2012; 44(6): 447-52.
  • Qian H, et al. “Treatment of acne scarring with fractional CO2 laser.” Journal of Cosmetic and Laser Therapy. 2012; 14(4): 162-5.
  • Huang L. “A new modality for fractional CO2 laser resurfacing for acne scars in Asians.” Lasers in Medical Science. 2013; 28(2): 627-32.
  • Kimura U, et al. “Biophysical evaluation of fractional laser skin resurfacing with an Er: YSGG laser device in Japanese skin.” The Journal of Drugs in Dermatology. 2012; 11(5): 637-42.
  • Cho SI, et al. “Evaluation of the clnical efficacy of fractional radiofrequency microneedle treatment in acne scars and large facial pores.” Dermatologic Surgery. 2012; 38(7 Pt 1): 1017-24.
  • Ong MW, Bashir SJ. “Fractional laser resurfacing for acne scars: a review.” British Journal of Dermatology. 2012; 166(6): 1160-9.
  • Wada T, et al. “Efficacy and safety of a low-energy double-pass 1450-nm diode laser for the treatment of acne scars.” Photomedicine and Laser Surgery. 2012: 30(2): 107-11.
  • Azzam OA, et al. “Fractional CO(2) laser treatment vs autologous fat transfer in the treatment of acne scars: a comparative study.” The Journal of Drugs in Dermatology. 2013; 12(1): e7-e13.
  • Lorenc ZP. “Techniques for the optimization of facial and non-facial volumization with injectable poly-l-lactic acid.” Aesthetic Plastic Surgery. 2012; 36(5): 1222-9.
  • Halachmi S, Amitai DB, Lapidoth M. “Treatment of acne scars with hyaluronic Acid: an improved approach.” The Journal of Drugs in Dermatology. 2013; 12(7): 3121-3.
  • Goodman GJ. “Treating scars: addressing surface, volume, and movement to expedite optimal results. Part 2: more-severe grades of scarring.” Dermatologic Surgery. 2012; 38(8): 1310-21.
  • Tenna S, et al. “Combined use of fractional CO2 laser and radiofrequency waves to treat acne scars: a pilot study on 15 patients.” Journal of Cosmetic and Laser Therapy. 2012; 14(4): 166-71.
  • Zhang Z, et al. “Comparison of a fractional microplasma radio frequency technology and carbon dioxide fractional laser for the treatment of atrophic acne scars: a randomized split-face clinical study.” Dermatologic Surgery. 2013; 39(4): 559-66.
  • Leheta TM, et al. “Do combined alternating sessions of 1540 nm nonablative fractional laser and percutaneous collagen induction with trichloroacetic acid 20% show better results than each individual modality in the treatment of atrophic acne scars? A randomized controlled trial.” The Journal of Dermatologic Treatment. 2014; 25(2): 137-41.
  • Lee SJ, et al. “Ablative non-fractional lasers for atrophic facial acne scars: a new modality of erbium:YAG laser resurfacing in Asians.” Lasers in Medical Science. 2014; 29(2): 615-9.
  • Shah S, Alam M. “Laser resurfacing pearls.” Seminars in Plastic Surgery. 2012; 26(3): 131-6.
  • Preissig J, Hamilton K, Markus R. “Current Laser Resurfacing Technologies: A Review that Delves Beneath the Surface.” Seminars in Plastic Surgery. 2012; 26(3): 109-16.
  • Mohammed G. “Randomized clinical trial of CO2 laser pinpoint irradiation technique with/without needling for ice pick acne scars.” Journal of Cosmetic and Laser Therapy. 2013; 15(3): 177-82.
  • Finlay AT, et al. “Classification of acne scars is difficult even for acne experts.” Journal of the European Academy of Dermatology and Venereology. 2013; 27(3): 391-93.
  • Kwok T, Rao J. “Laser management of acne scarring.” Skin Therapy Letter. 2012; 17(2): 4-6.
  • Sobanko JF, Alster TS. “Management of acne scarring, part I: a comparative review of laser surgical approaches.” American Journal of Clinical Dermatology. 2012; 13(5): 319-30.
  • Levy LL, Zeichner JA. “Management of acne scarring, part II: a comparative review of non-laser-based, nominally invasive approaches.” American Journal of Clinical Dermatology. 2012; 13(5): 331-40.
  • Munavalli GS, et al. “Successful treatment of depressed, distensible acne scars using autologous fibroblasts: a multi-site, prospective, double blind, placebo-controlled clinical trial.” Dermatologic Surgery. 2013; 39(8): 1226-36.

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What it is:  On June 21, 2011 the FDA approved a process by which a dermatologist or plastic surgeon numbs behind the ear, removes small pieces of skin, and sends these pieces of skin to a lab where the fibroblast cells in the skin samples are multiplied many times over and then frozen. These cells are then thawed when needed and injected into the skin under wrinkles or scars (boxcar or rolling) to help even out the appearance of the skin.

PROS: The body views these cultured cells as “own” and so the immune system does not respond. Working with your own cells eliminates allergic reactions, lumps, or abscesses which may come with other fillers. But probably the most compelling advantage is how long results last. Other fillers like bovine or synthetic collagen may last only a few months, and even more advanced fillers which combine polymer beads with collagen may only last a year or so. The LaViv treatment promises to last for years. As with many fillers, recovery is extremely minor and is evidenced by minor redness or bruising at the injection site. You can immediately return to work.

CONS: People don’t see results right away. The process requires 3 staggered injections and results aren’t seen until up to 3 months. It also costs a pretty penny–anywhere from $2000-$4000. However, other fillers which last less than a year can cost about $1000, so when you look at the long term, using your own cells may be more cost effective.

BOTTOM LINE: As always, the proof is in the pudding, and the pudding in this case is still cooking. This is such a new product and process that we literally haven’t had enough time to begin seeing “real” before and afters from everyday people posting online. There are 2 before and after pictures at this link which are provided by the company. Keep in mind as well that fillers are very often best used alongside other treatments, such as laser resurfacing.

A huge thanks to everyone on the scars team:

Aren, Miriam, Joel, Kent –> you guys rock.

Drumroll: Here’s the new Scars Page. It should have improved information and better usability. Please check it out and let me know what you think of it. If you find mistakes, I’d love to know what you found as well.


I’ve been pouring over scar research for days now. It is pretty endless, but I’m making progress. I’ve read through the latest summaries of research as well as a bunch of your comments on the scar treatment ratings pages. I have a couple of initial strong feelings:

1. Prevention is key! Scar treatment is hardcore–bleeding, oozing, bruizing, pain, long recovery time, permanent change in pigmentation at times, and major expense. It is far easier to prevent acne than it is to attend to scars. I happen to not be prone to scarring, but if I were, I would be diligent on the regimen and I would also be serious about creating anti-inflammatory action in my body. I’d be all about fish oil, zinc, eating well, exercising, and if I was healing from a pretty hardcore zit, I’d take an advil or two during recovery to prevent over-inflammation in my body and the scar response (this is only theorized and not proven to work, but I’d try it). I’d also refuse to pick at my skin, knowing that picking can cause as much scarring as the acne itself.

2. Scar revision is more of an art than a science. I’ve researched 19 different procedures so far. These 19 different procedures often need to be combined for best results. If I were looking for a doctor to take care of my scarring, I would look specifically for a plastic surgeon who specializes in acne scarring. Furthermore, I would not just take their word for it. Lots of people seem to “specialize” in whatever you’re paying $4000 for. Rather, I’d feel more comfortable if they themselves had scar revision treatment performed and if this is what got them into plastic surgery to begin with. I’d also make sure they had lots of before and after pictures for me to look at of their own previous clients. To give you an idea of what I mean regarding combination of treatments, if you have some ice pick scars, some narrow and some wide boxcar scars, and several rolling scars here and there, your treatment might consist of one or two punch excisions, one or two punch elevations, a bunch of subcisions, and perhaps some 75% TCA applied directly to a few scars. Then, 6 weeks would pass and you might get CO2 laser revision, followed by Er:YAG, or alternately, 5 medium depth TCA peels, with a little needling should it be required. I think you catch my drift.

I’m angered and motivated from some of the reviews you guys have written about doctors with a laser just sitting you down in the chair with no prep work and just lasering away, taking your $3500 and being done with it, leaving you with less than desirable results. Let’s help educate one another so those of us who need scar revision can be better advocates for themselves and others. I’ll post what I’ve got on the updated scars pages soon.

Hey you guys. I didn’t have time for a video today. I’ve been hard at work researching and writing the ethnic acne pages though, and it’s very interesting stuff. I can’t wait to get those up on the site. There are interesting differences in black, asian, latino, and white skin, and any combination thereof, albeit relatively minor differences.

Thanks for your comments from yesterday’s video btw. You guys really inspire me! :-) See you tomorrow!

I’m doin’ a bunch of research on acne and ethnic skin–which basically includes everyone in the world. But still, there are differences in skin depending on where your ancestors are from. Most notably are the red spots or dark spots that are left behind after active acne lesions heal. These red spots or dark spots are called post-inflammatory hyperpigmentation.