Debra Jaliman, MD, is a Board Certified Dermatologist and Dermatology Professor with a private practice in Manhattan, New York. Her dermatology practice focuses on both cosmetic dermatology and general dermatology. The dermatologist’s credentials include: Fellow – American Society of Dermatologic Surgery, Diplomate – American Board of Dermatology Diplomate, National Board of Medical Examiners, Dermatologic Surgeon, Board Certified – The American Academy of Dermatology, as well as being a Clinical Assistant Professor at Mount Sinai Medical Center. Dr. Jaliman has also helped Proctor & Gamble develop over seven hundred new dermatological products.
Q: What is the best procedure for acne scars?
A: Firstly, you should not have active acne when seeking these treatments. Often times with acne scars multiple modalities are required. The best procedure depends on the type of acne scar. Also, with acne scars sunscreen is a must.
For broad based scars (scars you stretch with your skin) you can use Medlite C laser (as well as other non-ablative lasers) and facial fillers. For ice pick scars, the most difficult ones to treat, the best option would be punch excision, or punching and skin grafting. For hypertrophic acne scars (thicker scars) steroid injections are the safest and most effective. Scar bandages including silicon sheets or Kelocote (a silicone gel) are also very effective for keloid scars.
Q: Can you tell me about facial fillers?
A: There are many categories. Facial fillers are a fast painless treatment which gives immediate results with no down-time. Some fillers are designed to last between 4-6 months and those are defined as a short duration filler. These fillers include the collagen based fillers Zyderm and Zyplast which are derived from highly purified bovine tissue and the human based collagen products which include Cosmoderm and Cosmoplast (with these the advantage is you don’t have to be skin tested). Hyaluronic acid fillers last for about 6-9 months ; these fillers include Captique, Hylaform, Restylane, Juvederm, and Perlane. The next category of fillers lasts a year to several years and these include Radiesse and Sculptra. Permanent fillers include Artefill and Silicone.
Q: Which type of acne scarring responds best to facial fillers?
A: Broad-based scars – meaning depressed, atrophic scars.
Q: What are your thoughts on chemical peels?
A: Chemical peels are good for people who have post-inflammatory hyper-pigmentation (just brown marks) and want to get rid of them but it is important to use light acids as stronger acids penetrate deeper and can cause more discoloration.
Q: What about the post red marks from acne?
A: The Genesis Laser and the Cool Glide laser are extremely effective.
Q: What kind of scars would benefit from subcision?
A: The scars that are bound down with deeper scar tissue.
Q: What do you mean?
A: The best way to describe it would be to think of a mattress then think of how the buttons are bound down. Some scars are bound down by scar tissue and need to be released.
Q: What about needeling for bound scars?
A: That does very well and is a very effective inexpensive procedure.
Q: What scars are treated with dermabrasion and does it work?
A: Very effective but requires two weeks of down-time and then redness can persist for months.
Q: Is microdermabrasion effective?
A: Yes, it helps with texture, color (brown discoloration) and makes the skin smoother and helps with the exfoliation. This also helps to increase the effectiveness of the products you use.
Q: What about silicone microdroplets?
A: Very effective for scars. It is most effective when performed every 4-6 weeks and the big advantage is this procedure treats many scars in the same treatment session and tends to be less expensive then facial fillers.
Q: Fraxel laser seems to be the next big thing. Can you tell me about this?
A: The Fraxel laser requires about 5 (if not many more) treatments. The way it works is it takes away about 20% of your skin at each session. The skin is heated and prompts new collagen formation. The big advantage is minimal downtime then other ablative lasers but it requires at lot of patience to see results and it is also very expensive.
Q: What about topicals for scar treatments such as copper peptides, alpha lipoic acid, Mederma, etc?
A: The only topicals that I have ever seen improve a scar include Renova, Retin-A, and Tazorac and silicone sheeting and gels.