Acne Scarring Laser Treatment

Acne scarring results from under treatment or delayed treatment of acne. Some acne does not scar despite being quite severe, other patients developed quite profound scarring despite minimal acne.

With so many good treatments available, many patients still get scars. We believe this to be unfortunate, And this should not be the case especially if access to qualified Dermatologist is available.

Patients with acne scars have a low self esteem and confidence and this can lead to social withdrawal, unemployment, lost relationships, significant depression and even suicide. 

How many types of acne scars are there?

Acne scars are of many types and one person may have a combination of these.

• Icepick
• Varicelliform
• Box car
• Rolling
• Hypertrophic
• Keloid

Professor Madan is credited with identifying a new form of acne scarring called papular acne scarring of nose and chin. 

Not all acne scars are alike and an individual with acne will have different types of scars. This means that there is no single best treatment for established acne scars. Each scar and patient should be treated individually according to the patients’ and the scars characteristics. 

What are the treatments for acne scarring?

Many treatments are available for acne scarring.

Most of these are physical methods and involve one form of surgical procedure or other aimed at correction.

Various surgical techniques for acne scarring include:

• Punch excision/elevation — these are suitable for deep ice pick scars or small box-car scars
• Undermining of scars/subcision —Subcision is usually performed for rolling acne scarring. It is performed using a special needle which is inserted through a puncture in the skin surface.

• Dermal fillers, collagen and fat transplantation — for depressed large scars which are not suitable for other treatments
• Microneedling – for superficial scars and where other treatments may result in side effects such as pigmentation.

Micro-Needling is a procedure where a small hand held pen device is passed over an area of skin; the pen has tiny needles to the tip of the device which penetrate into the underlying skin. This procedure does not remove the top layer of skin but forms a controlled injury to the skin. This initiates the skin’s natural wound healing process which works to replenish collagen and elastin fibres which may have been rendered ineffective as a result of ageing or injury to the skin. This new growth results in the formation of thicker and plumper skin which ultimately reduces the appearance of fine lines, wrinkles, scars and other prominent texture changes.

• Laser resurfacing-CO2 laser, Fractional laser

Fractional Carbon Dioxide Laser

How does fractional CO2 laser work?

The laser works by removing the top layers of your skin where a scar has formed.  As the top layer of your scar peels off, your skin appears smoother, and the appearance of the scar is usually less noticeable. The laser beam from a CO2 laser is divided up (fractionated) into thousands of very narrow beams of light which make tiny holes through the surface of the skin. As the skin heals this leads to the formation of new healthy collagen to tighten the skin and smooths the appearance of acne or other  scars.

How much improvement can I expect?

Studies have shown 30-50% improvement in acne scarring from approximately three treatment however results vary between individuals and results cannot be guaranteed. This treatment is not suitable for deep ice-pick scars.

How many treatments will I need?

Usually, one to three treatment sessions are required at about six-month intervals.

What does the procedure involve?

You will be asked to attend up to an hour before your treatment. The practitioner will apply numbing cream. 

The laser may feel uncomfortable but bearable. You will hear a vacuum in the room which will remove laser plume from the air.  

You may find it helpful to take paracetamol or ibuprofen before you come to the clinic. The procedure itself will take about 20-30 minutes. You will be provided with laser proof goggles to protect your eyes.

What to expect after treatment

You will be given a detailed aftercare sheet advising how to look after your skin day by day, following the laser treatment.  You should be prepared to take a week off work, contact sports and swimming. 

Following the treatment, the treatment area will look red, sore and swollen, like moderate sunburn. 

This is because the top layer of the skin has been removed, the swelling usually subsides within 4-5 days.

It is normal for the treated area to leak a serous fluid (pale yellow and transparent). This is the healing process beginning to work. If crusting is experienced, DO NOT attempt to dislodge or pick at the crusts as this may scar the delicate skin underneath. Instead, please bathe/cleanse the area very gently with fresh flowing water e.g., in a tepid shower to soften the crusting and help it to naturally lift off. Then apply a generous amount of the topical treatment as advised by your doctor (Lynton Light soothe/Vaseline/Prescriptive medication).

It is quite usual for the treated area to remain red for several weeks after the procedure. This is absolutely normal, eventually the redness will fade. This may take between 6 weeks and 4 months (in exceptional cases). You can use make-up to cover it as soon as the skin has healed (around 10-14 days).

To minimise the risk of pigmentation, it is extremely important that you use a broad-spectrum sunscreen (UVA & UVB) for at least six weeks to protect the skin. 

When will I see improvement?

Improvement in scars can be seen from a week after treatment but the skin texture can continue to improve for three to six months.

What are the possible side-effects?

Lightening or darkening of the skin pigmentation can occur after fractionated CO2 laser treatment. This is usually temporary but can be permanent. Darkening of the skin is more common in darker skin types and can sometimes be treated with topical treatments. Scarring can occur after CO2 laser treatment but this is uncommon. A flare-up of acne spots or white bumps (milia) can occur on the skin surface. Infection after CO2 laser treatment is possible but uncommon. If you have a history of cold sores you may be prescribed anti-viral medication to take before your treatment to prevent a flare-up of the cold sore virus.

What to expect after treatment

Following the treatment area will look red, sore and swollen. This is because the top layer of the skin have been removed. It is normal for the treated area to leak a serous fluid (pale yellow and transparent). This is the healing process beginning to work. 

The swelling should subside within 4-5 days but patients may experience some crusting as the skin begins to heal. If crusting is experienced, DO NOT attempt to dislodge or pick at the crusts as this may scar the delicate skin underneath. Instead please bathe/cleanse the area very gently with fresh flowing water e.g. in a tepid shower to soften the crusting and help it to naturally lift off. Then apply a generous amount of the topical treatment as advised by your doctor (Lynton Light soothe/Vaseline/Prescriptive medication).

It is quite usual for the treated area to remain red for several weeks after the procedure. This is absolutely normal, eventually the redness will fade. This may take between 6 weeks and 4 months (in exceptional cases). 

To minimise the risk of pigmentation, it is extremely important that you use a broad-spectrum sunscreen (UVA & UVB) for at least six weeks post procedure to protect the skin. 

TCA cross peel

• The TCA CROSS procedure involves depositing small amounts of TCA at high concentration onto the surface of the atrophic scar. This causes a local inflammatory reaction leading to the formation of new collagen fibres. The aim is to improve the appearance of the scar by increasing collagen and reducing shadows cast over scar depressions.
• Often times, a combination of the above treatments may be required.