Acne scarring treatments

10/02/24

This before and after image is an Asian gentleman’s cheeks after the first stage of treating his acne scars. Acne scars are very difficult to treat and at best you may get a 30-50% improvement. Multiple and deep scars often require multiple modalities performed several times for any discerning change. Also you must bear in mind that modalities with the greatest downtime (like CO2 or high heat Neogen), provide the greatest benefit.

 

This gentleman's post inflammatory hyperpigmentation had improved drastically with just 7 weeks of homecare! The before and afters also reveal a marked improvement of his atrophic scars and overall skin texture.

Case study:

This young man was conscious of his post acne scarring. He had researched and spent a fortune trying lots of over the counter creams but nothing was working. 

What he had was some localised atrophic (sunken) scars and post inflammatory hyperpigmentation (PIH). PIH is the result of the proliferation of melanin following inflammation and/ or trauma and is very common in skin of colour. In his case, it was as a result of acne. He also had ice pick scars, rolling scars and box scars. These are terms used to describe scars if you look at a skin biopsy in cross section. I could see that the pigmentation was more visible than the sunken scars so we prioritised treating this first.

There are several ways PIH can be treated:

Skincare and peels. Click here for more info and read what a patient says about her skincare regime here

Microneedling

Radio frequency microneedling

Red light therapy to assist healing

All of these are delivered at Dr K’s Clinic.

The sunken scars can be treated by several modalities: 

Topical high strength topical Tretinoin prescriptions and skin resurfacing with a phenol peel (like The Perfect Peel that is suitable for skins of colour) Click here for more info

TCA cross. This is a very high strength peel applied in drops to ice pick scars. This is a chemical burn delivered in specific areas, this causes the skin to shed and then newer skin comes to the surface. This is rarely 1 and done, it often needs to be combined with other modalities to make any discernible difference  Click here for more info

Minor surgery subcisions with a nokor needle where the tethered scar is released from below. This usually causes a lot of bruising. 

Skin punch biopsies can be described as removing a small cylindar of skin surrounding a deep scar and then the edges are brought together. The result is a small linear scar which is often less obvious than the sunken scar.

Injectables with Polynucleotides (Plinest, Plenhyage) Click here for more info

Skin boosters (Restylane Vital and Restylane Vital Light are used in clinic) Click here for more info

Skin remodellers like Profhilo Click here for more info.

Biostimulators like Lenisna, Juvelook, Sculptra.

Dermal fillers like Restylane, Belotero, Teoxane are used in clinic Click here for more info on fillers

For more aggressive resurfacing consider CO2 lasers and Neogen. This is when high heat is delivered to the skin, effectively causing a skin burn, when the skin heals, scars look that bit better. If recommended, you will be referred elsewhere.

My first-line therapy in this gentleman's case consisted of topical depigmenting agents that also act on the atrophic scars and could be delivered at home for cost effectiveness.

Here I used prescriptions of hydroquinone, tretinoin, hydrocortisone and niacinamide (B3 @phFormula) to reduce his pigment. The tretinoin and niacinamide will also help reduce the scars. As some of these topicals would give a lot of inflammation and irritation and potentially worsen his PIH, I also issued a gentle exfoliating cleanser (Exfo Cleanse @phFormula) and a soothing intense moisturiser with glycofilm, hyaluronic acid and vitamin E (SOS Rescue @phFormula) and of course a mineral SPF30+. I like to keep topical therapy to the bare essentials and add additional therapies if the hypermelanosis is particularly stubborn. PhFormula have Mela, TXN and Vita C that are fantastic as maintenance therapies. 

On review 7 weeks later he was amazed and very happy with his results! 

He was keen to take the next step and our aim was to improve the remaining uneven skin texture and slightly pitted scarring. We went through the options and we both agreed a course of polynucleotides. 

Happy patient= Happy doctor!

 

If you’d like an appointment with me, and you live less than 2 hours away, it’s better to see me in person for a 45-50 mins comprehensive assessment, as it’s helpful to touch and feel your tissue to see what treatment combinations will work best.

Those patients who live 3-4 hours away often want an online zoom consultation for an assessment. If they are treated with HA fillers or bio stimulating fillers, I ask that they stay locally for 3 days in case of rare adverse events. My online booking system is currently open. See the details below.

Our normal working days are: Tuesdays, Thursdays & Fridays and once a month Mondays. Our doctor led aesthetic clinic is set in the countryside between Wrexham and Chester. 

If you would like to book an appointment with Dr Kenningham, view availability or get the full address please click : https://www.drkenningham.co.uk/contact-me/#appointments