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Correcting acne scars: Acne scars: What’s the best treatment?

The Two Products I Swear by to Calm My Acne Scars

Raise your hand if you think that acne scars and dark spots—AKA hyperpigmentation—are harder to treat than that pesky pimple. 

Since my high school years, I’ve read article after article that touted the perfect acne scar and dark spot treatments (that would accommodate my sensitive skin, of course). I made sure to make room in my budget for what I hoped would be the holy grail to treating my scars and dark spots, but they still claimed residence on my skin. Beginning in mid-March of this year, another pesky, bright-red acne scar developed under my chin after a several week-long battle with an unwanted pimple. I used the extra time at home to experiment with new products, such as a niacinamide serum and retinol, to treat my newfound acne scar. Instead of fading the scar, these products made matters worse. Red splotches developed all over my cheeks, which I took as a sign to stop experimenting. 

 

The cream that’s like magic

Once June rolled around, I decided to find new solutions to treat the then three month-old acne scar, so I reached for a sample I had of Dr. Jart+’s Cicapair Tiger Grass Color Correcting Treatment. This color-correcting cream is seriously magic thanks to its hero ingredient, centella asiatica, an active ingredient anecdotally known for its calming properties. While it didn’t make the scar disappear, it hid the redness temporarily. Before applying my concealer, I swept this green-tinted cream on my red scar, ensuring that the color corrector blended seamlessly into my skin. The cream can also be applied to red spots and dark spots solo. I personally love to swipe a bit of this cream on my problem spots as the last step of my nighttime skin care routine. By morning, the spots are not as red as they were the day before, but this effect is only temporary. If you’re a tosser and turner though, I would not recommend putting this cream on at night as it can turn your pillow green.

One tub of this cream can last a long time. At $18 a tub, it’s a great value, given that it will last for several months. I graduated from my sample to a 0. 5 ounce tub in August, and I’m not even close to being empty. Since discovering this scar-covering cream, I regularly use it as a base for my makeup or as a nighttime spot treatment. Now, my worries about my scars showing are a thing of the past.

 

 

 

The scar-fading serum of my dreams

Besides the color-correcting cream being the closest thing I’ve found to magic, it wasn’t until I got my hands on Topicals’ Faded gel serum in August that my under-the-chin acne scar went away for good. The Topicals line was developed by founders who had skin considered less than perfect according to what was shown in movies and on TV, so I had a good feeling that Faded would be the remedy for all my scars and dark spots. After I consistently applied the gel on my face for two nights, it was gone! Even after the scar went away, I made sure to apply the gel at the recommended rate of 2-3 times a week. However, my skin did develop some pimples on my forehead and cheeks. These were expected, given that the packaging warned of skin purging, which is a result of irritation caused by the acids in the serum’s formula. I do think that $36 for this serum is relatively pricey, but every penny is worth it. Acne scars can take weeks or months to fade away, but in my experience, this serum got to the heart of the problem in a matter of days. Just like the color correcting cream, this serum can last for months, making the investment all the more worth your buck. 

 

 

Getting rid of the scars acne makes is far more challenging than popping that pimple. However, with Dr. Jart+’s Cicapair Tiger Grass Color Correcting Treatment and Topicals’ Faded serum, I feel in control of my skin and am empowered with the confidence that I can achieve a clear, glowing complexion. 

 

 

Dermatologists Dish on All Things Acne Scars and How to Erase Them

Most of us can relate: We picked at a pimple, and then picked at again, and then lo and behold, a scar was left behind, whether that be an “acne mark” like a dark spot, or a scar. And sometimes it occurs even without picking, which, of course, is incredibly frustrating. “Unfortunately, all skin types can be prone to acne scarring,” says Delray Beach, FL dermatologist Francesca Lewis, MD.

However, acne scarring varies greatly, from alterations in skin pigmentation to changes in texture, which is what we think of when we think of traditional scars, like those from surgery. “An alteration in the skin’s surface is what we consider a ‘real scar’ and not color change,” adds Spokane, WA dermatologist Wm. Philip Werschler, MD. Here, we get all the details on acne scarring, straight from the pros.

Which skin types and colors are most prone to discoloration from acne scarring?

When dermatologists discuss skin types, they classify them using the 6 Fitzpatrick Skin Types (FST), with 1 being the most fair skin that always burns and never tans, and 6 being dark brown or black skin that never burns and always tans. “Interestingly, we see the most significant pigmentary alteration—hyperpigmentation ‘dark scars’— in the middle skin types, especially FST 3 and 4,” says Dr. Werschler. “There is a tendency to see post-inflammatory erythema—redness or ‘red scars’—in FST 1 and 2. Hyperpigmentation is more difficult to spot in FST 5 and 6. With excessive manipulation, any skin type can develop ‘white scars’ or areas of pigment drop out, which is referred to as post-inflammatory hypopigmentation. This is very hard to treat and also cover up.” Dr. Lewis agrees, saying it is common to see pink scars in fair-skinned patients and hyperpigmented scars in darker-skinned patients.

What about textured scars (versus discoloration)?

“We divide scars into three basic types: elevated or hypertrophic/keloid; depressed or pitted or atrophic; or flat with textural change,” Dr. Werschler explains. “The vast majority of textural and depressed acne scars results from picking, manipulation, poking, etc. Elevated or papular or hypertrophic scars—the first group—are frequently from a genetic predisposition to heal with an over-abundance of collagen. This can happen in all skin types, but is more common in FST 1, 5 and 6.”

Though genetics play a role, Dr. Werschler says redheads and darker skin types seem to be predisposed. “Historically, African Americans were considered to be more prone to keloid-type scarring, but this type of scar can occur in any skin type,” adds New York dermatologist Doris Day, MD. And though these types of raised scars can occur on all areas of the body, they’re more common on the chest, jawline, tops of shoulders and even earlobes.

Atrophic scars are described as flat, shallow depressions that heal below the top layer of skin. “This is another form of acne scarring, which includes different types like boxcar scars, ice pick scars and rolling scars,” says Dr. Lewis. Boxcar scars typically result from widespread acne on the lower face, and are usually box-like with defined edges. Ice pick scars are also common on the cheeks and lower face, and look like smaller, more narrow indentations that point downward into the skin, as if an icicle were to prick your cheek. Rolling scars appear wavy and vary in depth across the skin.

What are the best topical products to use for treating hyperpigmentation from acne scars?

Though hydroquinone is a hot button ingredient, Dr. Day still considers it the gold standard for lightening dark spots. “I typically use a 4-percent formulation, and often combine it with tranexamic acid, vitamin C and retinol. However, arbutin is a good and safe substitute for hydroquinone,” she says. “I love my Ultra Brightening Cream for hyperpigmentation from acne or from the sun. It contains arbutin, vitamin C ester and a gentle yet powerful retinol called HPR. I also like philosophy Miracle Worker.”

Dr. Lewis is also a fan of hydroquinone, but most often recommends a combination of prescription and medical-grade skin lighteners to help fade the scars. “A mainstay of treatment is prescription-grade hydroquinone, which will help effectively lighten the marks over a period of two to three months. We may also combine ingredients such as kojic acid, arbutin, tranexamic acid, and azelaic acid in prescription compounded topical creams or medical-grade skin care.”

Washington, D.C. dermatologist Tina Alster, MD prefers “a combination of A Method C Antioxidant Gel 20%—to brighten skin in the morning under sunscreen—and A Method Advanced TX Lightening Gel Elixir to fade pigmentation at night while sleeping. The TX stands for tranexamic acid, which lightens and corrects skin discoloration.”

Dr. Werschler considers himself “a bit old school” on treatments, but his protocol almost always involves an “old-formula combination of tretinoin, hydroquinone and triamcinolone. “This is referred to eponymously as the Kligman formula,” he says. “But there are many good OTC products out there as well.”

Regardless of skin type, all dermatologists stress the importance of using sunscreen to minimize redness and hyperpigmentation from acne, and to help it heal with minimal to no scarring. “I recommend applying a zinc-based SPF every single morning,” adds Dr. Day.

Which in-office treatments are best for correcting hyperpigmentation from acne scars?

Hyperpigmentation can be treated with a variety of interventions, from light microdermabrasion to superficial fractionated laser treatments. Although Dr. Alster recommends laser treatments for a wide variety of scars, including keloids and atrophic acne scars, she prefers a different method for treating hyperpigmented acne scars. “I use either chemical peels or microneedling because these treatments do not heat the skin, which often worsens hyperpigmentation,” she explains.

Dr. Lewis also utilizes chemical peels for pigmented scars, as well as “microneedling treatments or ResurFx laser for depressed scars, IPL—Intense Pulsed Light—or excel V for pink scars, and the Clear + Brilliant laser for overall skin tone and rejuvenation.”

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Erasing Your Acne Scars with PicoSure® Laser Skin Revitalization: Richard Blanchar, MD: General Practitioner

It is estimated that more than 20 million Americans are affected with scars caused by acne. Most acne scars are formed by picking/squeezing whiteheads, blackheads, or cystic acne resulting in scarring. Now, the number of Americans affected by acne scars has the opportunity to drastically decrease with the help of a new laser skin treatment. The PicoSure® Laser is here.

While there are a number of treatments available that improve acne scars, none of them are as effective as PicoSure® Laser treatments. It is important to understand that other treatments out there are often used “off-label” and are considered simply experimental until FDA approval. FDA approval is only achieved by conforming to strict guidelines in clinical trials for many months or years to show safety, efficacy and controlled results. Many try and many fail. The PicoSure® Laser is still the only FDA approved treatment for Acne Scars.

Why PicoSure® Laser Treatment Works

Pico is used as a prefix, in units of measurement, defined as 1 trillionth of a second. The word “Pico,” in PicoSure®, refers to the speed of the laser energy output and rate at which the energy is delivered (1 trillionth of a second. ) Other laser devices operate in the billionths of a second or less. Slower lasers take more time for the energy to be delivered and remain on the tissue longer increasing the chance for burns and other damage (i.e. hyper/hypopigmentation) from excess laser energy or heat. By releasing ultra-short and faster pulses of laser energy into the skin, we avoid unwanted side effects.

When the FDA was testing the PicoSure® Laser in 2014, it was officially approved in July for an indication to treat Acne Scars. 86% of the patients in the clinical trial showed significant scar improvement.
The laser energy safely remodels the collagen and important structures of the skin without permanent damage to the surrounding tissue.

However, the PicoSure® Laser isn’t just for correcting scars from acne. It’s also the first and only FDA approved laser for tattoo removal treatment. The controlled short bursts of safe laser energy are focused at the desired treatment area and break up the ink into microscopic particles that leave no scars or damaged skin.

What to Expect During a PicoSure® Laser Treatment

PicoSure® Laser treatments usually take between 15 to 20 minutes. A majority of patients will begin to see real results after 1 session and full correction after three sessions. Your skin may appear red or feel flush after your first treatment, that’s completely normal. You may apply ice to the area(s) at 5 minute intervals for the first day to relieve any sensation of heat (if any.) If redness occurs, it will typically last 1-2 days.

Since Dr. Blanchar’s office is located in sunny Fort Lauderdale, Florida, we strongly advise our patients to avoid excessive sun exposure as best as they can for up to 2 weeks before their appointment. If you have sunburn or show signs of obvious sun exposure, the treatment will be postponed for another 2 weeks.

Interested in PicoSure® Laser Treatment?

The PicoSure® Laser is the most advanced generation of Aesthetic Lasers available in the U.S. today.
We are pleased to offer the laser in our office 8:30am – 5:00pm, Monday thru Friday.     Call 954-776-6992 to schedule your appointment or free consultation with Richard Blanchar, M.D.

How to Cover Acne Scars in 5 Steps – THE YESSTYLIST – Asian Fashion Blog

Estimated Reading Time: 3 minutes

Acne scars or dark spots take a while to heal. It can take weeks or even months before you completely get rid of them. While you wait for your acne scars to disappear, especially with the help of skin care products like Vitamin C, you can use makeup to conceal them.

Using makeup to cover acne scars is easy as long as you follow the right application techniques and use the right makeup products. Patience is also key! Using makeup to cover acne scars will take more time than your usual makeup routine so it’s essential to stay persistent in order to get a flawless finish.

The next time you notice new blemishes, follow these five steps to conceal the scars:

Step 1 — Start with a good primer

Remember to always start with a good base otherwise your makeup won’t last as long. Prep your skin with a primer to balance out the texture of your skin and minimize the appearance of your pores.

Go for a primer like Aritaum’s Pore Master Sebum Control Primer, which creates a smooth canvas for makeup. This primer will smooth over your problem areas, mattify shine and reduce the appearance of pores. It’s also infused with plant-based extracts, including Centella asiatica, morus bark, green tea, yuja, and lemon verbena leaf extracts, to soothe the skin.

 

Step 2 — Grab a color correcting concealer

Hiding acne scars can be tricky especially if your spot is red or inflamed. Luckily, you can easily correct this with a color correcting concealer.

Color correctors are great for canceling out unwanted hues in your skin. Green concealers help neutralize the appearance of redness. Yellow concealers are perfect for evening out an uneven skin tone and purple concealers help cancel out unwanted yellow tones while brightening up a dull complexion. If under-eye dark circles are what you’re trying to hide, think pink concealer!

The HD Pro Concealers from L.A Girl Cosmetics boast long-wearing and crease-resistant coverage, making them perfect for concealing acne scars. For a natural finish, blend out your color corrector with a beauty sponge. And remember, color correctors are applied before your foundation and main concealer.

Step 3 — Go for a full coverage foundation

Choosing the right type of foundation is just as important as picking the right primer. Use a non-comedogenic foundation that won’t clog your pores or cause your skin to break out. A full coverage foundation with a matte finish is ideal for oily skin or skin with acne scarring.

If you want your scars to look completely non-existent, go for VDL’s Perfecting Last Foundation. This liquid foundation is lightweight but provides full coverage to ensure all your imperfections are covered. The Perfecting Last Foundation comes in a variety of 10 shades and even offers SPF30 PA++ so you get a bit of extra protection from the sun. The foundation also gives a luminous and flawless finish, thanks to its formula containing a Light-Fitting Cover Complex™ and Lumilayer Pigment™. 

Step 4 — Look for a full coverage concealer

After you’ve gotten some coverage with your foundation, it’s time to reach for not just one, but two concealers. First, pick a concealer that’s one or two shades lighter than your skin tone. Never rub concealer on scars, dab it instead for a natural finish. 

Let your first concealer settle for a bit before you apply your main concealer. Pick a concealer that matches your skin tone and make sure you know your skin undertone so the shade you use perfectly matches your skin. 

Acne scars tend to look dry so applying a creamy concealer like CLIO’s Kill Cover Liquid Concealer will provide just the right amount of coverage without making your scar look cakey. The Kill Cover Liquid Concealer provides high coverage that’s buildable. It’s both lightweight and long-lasting, plus it’s non-greasy so you won’t have to worry about getting midday shine! 

Step 5 — Finish with pressed powder

After you’ve effectively concealed all your acne scars with your color correctors, foundation and concealers, it’s time for the finishing touches. The last step is to apply loose powder to set your makeup in place.

Applying too much powder can make you look cakey so to avoid this, choose a powder that’s finely milled like SHANY’s HD Finishing Powder Translucent. This powder diffuses the appearance of imperfections and sets your foundation perfectly. It’s also paraben and talc-free, making it suitable for all skin types. 

SHANY’s HD Finishing Powder Translucent is great for daytime makeup but if you’re planning a night out, then you’ll need something with higher coverage that won’t look powdery. The Blur Powder Pact from EGLIPS might just be what you’re looking for. This finely milled powder absorbs excess sebum and gives a smooth and flawless finish. You can also keep this compact powder in your handbag for touch-ups if needed.   

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How to Remove Acne Scars

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Roughly 50 million Americans suffer from acne every year, and anyone who does knows about nasty scars acne can leave. Often times, these marks last way longer than the actual blemish itself and can be harder to treat. “Scars can be divided into two [categories] – dark marks that are actually a result of post-inflammatory hyperpigmentation, and the other type which involves a change in skin texture resulting in depressed or raised scars,” explains Dendy Engelman, MD, a dermatologist in New York City.

Dark mark scars crop up generally as superficial pink, red, or brown marks. Dr. Engelman suggests looking for salicylic acid or glycolic acid peels that will help promote cellular turnover to remove the top layers of the skin. This hyperpigmentation, can be faded with brightening ingredients like hydroquinone, kojic acid, phytic acid, and l-asorbic acid,” she says, or LED or photodynamic light therapy can also help fade the mark.

Texture scars, which are raised or sunken marks on the skin, can be treated with microneedling, dermaroller, fractionated Co2, and deep chemical peels, which actually slightly damage skin to help promote collagen production and fill scars from within, says Dr. Engelman.

“Post inflammatory hyperpigmentation (PIH) can persist for weeks to months and is often more problematic than the underlying acne itself,” says Valerie Harvey, MD, a dermatologist in Virginia. “Treating the underlying acne early and effectively is important in the prevention of PIH, and options include topical lightening creams that include ingredients such as hydroquinone, tranezamic acid, niacinamide, and kojic acid, or chemical peels.”

Here are some of the best treatments for acne scars packed with skin brighteners and healers to fill deep face scars, fade dark spots, and help heal acne scars for good:

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1

Best for Dark Acne Scars

SkinCeuticals C E Ferulic

Vitamin C blocks the enzyme responsible for melanin (or pigmentation) production, which means it brightens skin and prevents hyperpigmentation and dark spots.  

“This product is the gold standard for brightening skin,” says Dr. Engelman. “It will noticeably reduce fine lines and wrinkles while improving overall skin appearance.” 

2

Best for Improving Skin Texture

SkinMedica Rejuvenative Toner

amazon.com

This acne-fighting cocktail contains lactic acid, glycolic acid, citric acid, and malic acid. “Each is a natural, alpha-hydroxy acid (AHA) that provides mild exfoliation to help enhance skin texture and reveal healthy new cells,” says Dr. Engelman. Apply this after cleansing the skin and before applying your favorite moisturizer. 

3

Best for Deep Acne Scars

Environ Gold Roll-CIT

Micro-needling is procedure that causes tiny, controlled injuries “deep within the skin to trigger the body’s natural collagen rebuilding process,” says Dr. Enelman, which fills scars from within, creating a smoother skin surface. The service is offered in a dermatologist’s office, but this at-home dermaroller can help you achieve the results yourself (in your pajamas!).

4

Best LED Light Therapy for Acne Scars

Neutrogena Light Therapy Acne Spot Treatment

There’s no need to go to the dermatologist’s office for LED light therapy. For ten minutes per day, treat your skin to this blemish-fighting futuristic spot treatment that you place over pesky blemishes to zap them away. 

The red light reduces acne inflammation, while the blue light targets acne-causing bacteria. Additionally, the light stimulates the dermal layers of the skin and produce additional collagen. In turn, acne scars fill out and the skin looks more even-toned. 

5

Best For Targeting Dark Spots

Murad Rapid Age Spot and Pigment Lightening Serum

Treat discoloration with a spot treatment that helps fade dark spots with the help of hydroquinone, which Dr.  Engelman says can brighten hyperpigmentation. Several reviewers claim that they saw an improvement in skin tone/texture in as little as a week! 

6

Best Retinol Treatment for Acne Scars

Differin Gel

Prescription retinoids are the gold standard increasing cell turnover,” says Dr. Engelman. This gentle yet effective retinoid ramps up “cell turnover, builds collagen, improves discoloration, hydrates skin and reduces acne,” explains Dr. Engelman. “Topical vitamin A derivatives like retinol and RX retinoids can help to tighten the appearance of the skin and make scars less apparent.”

7

Colorescience Sunforgettable Total Protection Brush-On Shield

Using a sunscreen is important 365 days a year, but especially if you’re trying to prevent and fix any hyperpigmentation.  “This 100% mineral sunscreen provides protection while still feeling lightweight,” says Dr. Engelman. “It is also oil-free, yet calming with niacinamides.”

8

SkinMedica Lytera 2.0 Pigment Correcting Serum

amazon.com

$154.00

$138.60 (10% off)

For overall brightening, use this serum with phytic acid, a proven skin brightener according to Dr. Engelman. This ingredient provides a chemical exfoliation that restores the skin’s radiance, and therefore helps enhance skin texture for a flawless complexion. 

9

In-Office Treatment: Juvederm

Best For Deep Acne Scars
Prices vary.

Another in-office option for texture scars is by creating a subcision filled with hyaluronic acid filler (Dr. Engelman recommends Juvederm) to reduce the appearance of depressions and pock marks in the skin caused by acne. Depending on how fast your metabolism is, results can last anywhere from six months to two years.

Pia Velasco
Pia Velasco is the Associate Beauty Editor at Good Housekeeping, Woman’s Day, and Prevention magazine.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

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The best creams to remove acne marks in India

Our teenage years were defined by acne and despite what our mums said, we touched and popped it which resulted in acne scars. While brightening creams and spot treatments don’t cut it and visiting the doc’s office isn’t an option, we scoured the internet for the acne mark fading treatments available that will give you blemish free skin.

Best Acne Scar Removal Creams

Here is the top 10 most effective products and creams to remove acne marks in India

Bio-Oil, Rs 350

A cult favourite that’s spotted on celebs bathroom shelves, this hydrating oil is absorbed into your skin in seconds and is known to fade deep acne scars. It’s also a great treatment to fade stretch marks.

Buy it here

Palmer’s Eventone Dark Spot Corrector, Rs 1901

If dry skin AND acne marks are getting your down, you need Palmer’s eventone dark spot corrector that lightens acne scars and sunspots thanks to the Vitamin C concentrate.

Buy it here

The Ordinary Lactic Acid 5%, Rs 583 approx

Canadian beauty brand The Ordinary has become a millennial favourite, thanks to it’s affordable price tag while still delivering results. The lactic acid concentrate serum contains AHAs that gently exfoliate the skin and helps reduce the appearance of acne scars. It’s also enriched with hyaluronic acid that will help enrich your skin’s lipid barrier, preventing it from further damage.

Buy it here

Mederma Skin care gel for acne scars, Rs 450

Mederma means business – it’s used to fade surgical scars, burns and stretch marks, making fading scars seem like an easy feat. What’s more, it’s Dermat approved.

Buy it here

Murad Post-Acne Spot Lightening Gel, Rs 5735

This clear gel has hydroquinone (a bleaching agent) as its core ingredient that will soothe inflamed skin and eliminate dark spots.

Buy it here

Bioderma Sebium Sérum, Rs 1540

This chemical peel from French beauty giant Bioderma helps refine the skin’s texture, regulates sebum and fade dark spots over four weeks.

Buy it here

Agelock Acnesis Treatment Serum, Rs 1700

Specially formulated for oily skin, this lightweight serum works double duty – it prevents acne while fading acne marks and locking in moisture, unlike most anti-acne products.

Buy it here

Kiehl’s Clearly Corrective Dark Spot Corrective Solution, Rs 4650

A cult product from New York skin care giant Kiehl’s, this serum is loaded with activated C, white birch and peony extracts that penetrates into the skins layers to reduce the appearance of all those marks. The result? An even skin tone that’s brighter with zero scars.

Buy it here

Estee Lauder Enlighten Dark Spot Correcting Night Serum, Rs 5900

This overnight treatment contains a cocktail of salicylic acid, caffeine and turmeric and grapefruit extracts that work on reducing scars within two weeks.

Buy it here

Clinique Even Better Skin Tone Corrector , Rs 4600

Clinique is known for its science oriented beauty formulas. This oil-free serum is lightweight to wear under your makeup and evens out your skin tone over repeated usage.

Buy it here

Fillers for the improvement in acne scars

Uwe Wollina,1 Alberto Goldman2

1Department of Dermatology and Allergology, Academic Teaching Hospital, Dresden-Friedrichstadt, Dresden, Germany; 2Clinica Goldman, Porto Alegre, Rio Grande do Sul, Brazil

Abstract: Acne is a common inflammatory disease. Scarring is an unwanted end point of acne. Both atrophic and hypertrophic scar types occur. Soft-tissue augmentation aims to improve atrophic scars. In this review, we will focus on the use of dermal fillers for acne scar improvement. Therefore, various filler types are characterized, and available data on their use in acne scar improvement are analyzed.

Keywords:
acne, scars, dermal fillers, injection, extracellular matrix

Introduction

Acne is a common disease. Its prevalence is ~80%.1 Almost 10% of the World population are affected.2 Onset of acne in most patients is during puberty, but acne among adults, especially females, is not rare.3,4 Scarring is an unwanted end point of the diseases and not restricted to severe disease subsets.1,5

For clinical trials and scoring of severity of acne scars, several algorithms have been developed. The most popular is the “Quantitative Global Scarring Grading System for Post-acne Scarring”6 of which a Brazilian Portuguese version exists. 7 Skin picking syndrome is a differential diagnosis of acne scars with an overlap in acne excoriee.8 The Quantitative Global Scarring Grading System for Postacne Scarrin” differentiates four grades: I with macular flat marks of different color; II with mild atrophic or hypertrophic scars; III with moderate atrophic or hypertrophic scars; and IV with severe atrophic or hypertrophic scars.6

Acne scars

The mechanism of scarring in acne is complex. The basic inflammatory process of acne becomes more pronounced in patients with acne scarring.9 This leads to an aberrant remodeling of the extracellular matrix (ECM) in pilosebaceous units of skin. Propionibacterium acnes and other gram-positive bacteria are capable to increase the formation of matrix metalloproteinase-2 in sebocytes and skin fibroblasts, which may contribute to a distorted degradation of ECM.10 Furthermore, peptidoglycans of gram-positive bacteria enhance the production of prostaglandin E2. 11

Color scarring in skin is more common and often associated with postinflammatory hyperpigmentation. This can be due to genetics, pigmentation, and differences in skin care.12

There are different clinical types of acne scars, ie, atrophic and hypertrophic scars. Atrophic scars can be further differentiated into deep and narrow icepick scars, larger rolling scars, and depressed boxcar scars (Figure 1). Hypertrophic scars and acne keloids represent the hypertrophic variants.13

Figure 1 Acne scars.
Notes: (A) Rolling acne scars with an undulating appearance; (B) acne boxcar scars with a round or oval shape resembling varicella scars; and (C) icepick scars are sharply demarcated, narrow, and deep.

Acne scar management needs an effective control of inflammation, which could prevent scarring. The treatment of scars includes different approaches, namely, camouflage, peelings, microneedling, subcision, and laser therapy for atrophic scars. Hypertrophic scars may be treated by cryotherapy, corticosteroids injections, laser, and surgery.13,14 All procedures may improve scars but cannot establish a scar-free skin.15

In this review, we will focus on the correction of ECM aberrations by the use of dermal fillers with the focus on atropic acne scars.

Dermal fillers

Dermal fillers can be classified as temporary, semipermanent, and permanent (Table 1). Although the first two classes are biodegradable with a broad range of half-lives, permanent fillers are not biodegradable.16 Fillers induce a characteristic ECM response that allows a histopathological identification of various filler types.17

Table 1 Dermal filler classification

Tolerability and safety of dermal filler implantation are dependent upon filler qualities, skills and knowledge of the medical doctor, and patient characteristics.18–20

The injection of dermal fillers to improve acne scars is based on soft-tissue augmentation. Hyaluronic acid fillers (HAFs) stimulate collagen production. A stronger stimulation of collagen production is seen with semipermanent or biostimulatory fillers, ie, poly-l-lactic acid (PLL) and calcium hydroxylapatite (CaHA), and permanent fillers.17

Basic knowledge of filler qualities, injection techniques, and anatomy is indispensable. Fillers should not be used in children and youngsters, in pregnant or nursing women, in patients with immune disorders, allergies against filler materials, and infections. Filler implantation warrants hygienic standards and should not be used in case of dental root procedures and skin barrier injuries to minimize the potential risk of infection. Knowledge of possible unwanted adverse effects, their prevention, and management are prerequisites.21

Several injection techniques are used, such as serial punctures, linear threading, fanning and cross-hatching, deep bolus, or superficial microdroplet injections.21 Cooling of the skin before and after injections reduces pain and bruising. 22

Dermal fillers for acne scars – clinical evidence

Silicone microdroplet injections

Medical-grade silicon has been used for a long time as a type of permanent filler in soft-tissue augmentation (Table 2). Proponents of silicon argue that the product is stable, has some antimicrobial activity, and is relatively cheap. Repeated microdroplet silicone injections are recommended with long-lasting effects.23,24

Table 2 Clinical trials with dermal fillers for atrophic acne scars
Abbreviations: HA, hyaluronic acid; incl, including; PMMA, polymethylmethacrylate; PLL, poly-l-lactic acid; CaHA, calcium hydroxylapatite; HAF, hyaluronic acid filler.

A 1,000 centistoke-injectable silicone emulsified with hyaluronic acid (HA; Silikone® Alcon, Fort Worth, TX, USA.) was used in 95 patients for tissue augmentation with only minor temporary adverse effects.24 The American Society for Dermatologic Surgery listed acne scars as a possible indication for liquid silicone injections. 22

The 1,000 centistoke silicone oil is Food and Drug Administration (FDA) approved “for use as a prolonged retinal tamponade in selected cases of complicated retinal detachments where other interventions are not appropriate for patients.”25 None of the silicone products are approved as soft-tissue fillers. Cosmetic filler injections have been associated with severe adverse effects, such as infection, calcifications, pneumonitis, pulmonary embolism, renal failure, and death.26,27 Although many of these severe complications were noted by unlicensed practitioners or lay people, the use of silicone is off-label and is not recommended by us.28 Migration of silicone is another problem, leading to unwanted adverse effects.29

Polymethylmethacrylate microspheres

Polymethylmethacrylate (PMMA) is an inert, synthetic permanent filler material that induces fibrous capsule formation in animals.30 For cosmetic use, 20% PMMA microspheres are suspended in an aqueous solution of bovine collagen and lidocaine (Artecoll® and Artefill® Canderm Pharma, Saint Lorent, QC, Canada). Artecoll® and Artefill® have the same composition, although the microspheres are somewhat smaller in Artefill®. In the hands of experienced users, patient satisfaction with PMMA-tissue augmentation is high and the effect is long lasting.31,32 Most patients experience a moderate improvement.33,34 However, adverse effects can also be long lasting due and very nasty to the permanent nature of this filler material.31

Nevertheless, in 2014, Bellafill® (previously named Artefill®) has got FDA approval “for moderate-to-severe, atrophic, distensible facial acne scars on the cheek in patients over 21 years of age.”25 This makes Bellafill® the first FDA-approved medical device for correction of acne scars. The scientific background is based on the clinical trial SUN-11-001, a prospective, randomized, multicenter, and evaluator-blind study for correction facial acne scars on the cheek. Patients were randomized 2:1 for Bellafill® (n=87) or sterile saline injection.46 Adult patients with Fitzpatrick skin types-I–VI were included. Data were analyzed at 6 months and after 12-month follow-up. Patients in the control group received on average higher injection volumes in primary treatment session and touch-up. Treatment-related adverse effects were noted in 14 patients with Bellafill® and in none of the control group. Bruising, injection pain, erythema, and lumpiness were observed but mild-to-moderate in 13 of the 14 patients. One case suffered from severe bruising.35

Polyacrylamide

Polyacrylamide is produced by polymerization of acrylamide monomers and by cross-linking with N,N′-methylenbisacrylamide. Aquamid® is a nonabsorbable hydrogel that consists of 2.5% cross-linked polyacrylamide and 97.5% water. Although it has been extensively used for soft-tissue augmentation, no controlled trial of Aquamid® for acne scars has been identified. 36 Two uncontrolled trials not exclusive for patients with acne scars reported high satisfaction rates and up to 5% adverse effects, such as swelling, lumpiness, and abscess formation.37,38

Poly-l-lactic acid

PLL is a biodegradable, semipermanent, and biostimulatory filler stimulating fibrous tissue formation. The commercially available product (Sculptra® and Newfill® Dermik Laboratories, Bridgewater, NJ, USA) consists of PLL microparticles, sodium carboxy-methylcellulose, and mannitol. Soft-tissue augmentation may last for up to 2 years.22

Two open trials and case reports recorded a significant improvement in atrophic acne scars, which may last for up to 4 years.39–41 Nodules developed in a single patient.41 Nodule formation with PLL can be due to too superficial injection and/or inappropriate dilution. A higher dilution than used for correction of human deficiency virus-associated midfacial lipoatrophy is recommended.

Calcium hydroxylapatite

CaHA is a synthetic, biodegradable, semipermanent, and biostimulatory filler. The commercially available product (Radiesse® Merz Pharma, Frankfurt, Germany) contains 30% CaHA microparticles suspended in a carboxy-methylcellulose gel. CaHA stimulates collage production. Soft-tissue augmentation lasts for up to 18 months.42 Open trials reported improvement in boxcar scars but failure in icepick scars, suggesting for a combination of CaHA with subcision for better outcome.43,44

Collagen

Collagen fillers are temporary fillers of either bovine, porcine, or recombinant human origin. The predominant collagen is collagen I as in human dermis. For bovine collagen fillers (Zyderm® I and II, INAME Aesthetics, Santa Barbara, CA, USA), two intradermal skin tests 2–4 weeks apart are recommended due to its allergenic potential. The skin test is not necessary for porcine collagen (Evolence® ColBar LifeScience, Herzliya, Israel) or recombinant human collagen (Cosmoderm® and Cosmoplast® Allergan, Dublin, Ireland). Collagen fillers should not be used in patients with autoimmune diseases or collagen hypersensitivity. Soft-tissue augmentation usually persists up to 6 months.45–47 The use of collagen fillers for atrophic acne scars was recommended by the American Society for Dermatologic Surgery.22

A case report suggested that in some patients, the effect may persist for at least 12 months.48

Hyaluronic acid filler

HA is a glycosaminoglycan polysaccharide and a physiologic component of ECM. Natural HA has the disadvantage of a short half-life of 12 hours only. Therefore, various technologies for cross-linking have been developed to stabilize HAF. Linking agents include 1,4-butanediol diglycidyl ether, divinyl sulfone (DVS), and 2,7,8-diepoxyoctane. Modern HAFs are produced by bacterial fermentation. HAF can be divided into mono- (Esthelis® Anthies, Geneva, Switzerland/Belotero® Merz Pharma, Frankfurt, Germany, Juvederm® Allergan, Dublin, Ireland, etc) or biphasic (Perlane®, Restylane® Galderma, Sophia Anitpolis, France), whereas biphasic fillers contain HA particles suspended in HA gel. 18

HAFs differ in their cross-linking technology, percentage of cross-linking, the amount of HA and bound water, viscosity, hardness, cohesivity, HA concentration, gel-to-fluid ratio, degree of HA modification, swelling, modulus, particle size (for biphasic HAF), ease of injection, and approved indications.49 This allows tailored treatment of various conditions. Injection of HAF stimulates collagen production by fibroblasts contributing to soft-tissue augmentation.50

Open trials suggest a high treatment satisfaction of patients. Most common adverse effects were mild transitory erythema and mild-to-moderate pain during injection.51,52 Pneumatic injection of HA was used in two patients to improve acne scars by one grade.53 HAF offers the opportunity of a rapid correction of nodules, etc, by the use of hyaluronidase injection.54

Comparison with other treatments for atrophic acne scars

All treatments for acne scar aim not to cure but to make the scars less visible. Among surgical procedures, subcision and microneedling are the most popular with good efficacy in atrophic acne scars except icepick scars. Punch techniques may be used for icepick scars.55 Ablative lasers, such as CO2 or erbium:yttrium aluminum garnet (Er: YAG), are effective in atrophic acne scars. Ablative fractional lasers have also been investigated and demonstrated an improved risk profile. Multiple treatments are necessary in case of deep scars. Nonablative lasers may be used in mild acne scarring as an alternative. Laser treatments are relatively expensive and have their own risks, such as postinflammatory hyperpigmentation – particularly in ethnic skin – and scarring.56

Deep peels with trichloroacetic acid alone or in combination with other peels or microneedling can improve atrophic scars. Repeated treatments may be necessary depending on the depth of the scars. A 100% trichloroacetic acid peel is capable to improve even icepick scars.57

Other techniques have been developed, but clinical data of controlled trials are missing.

Conclusion and outlook

Dermal fillers belong to the armamentarium to improve acne scars. Their capability to augment soft tissue is the most obvious advantage. Tolerability, durability of the augmentation, adverse effects, and risk profiles differ between the various dermal filler types. Permanent fillers may exert very long-lasting effects, but in case of unwanted adverse effects, the complete removal of the material may be necessary. Temporary fillers need repeated treatments increasing the costs. HAFs have been shown to improve skin quality over time. Semipermanent fillers seem to be a good alternative. For safety reasons, deep injections are recommended.

When should dermal fillers be considered? Dermal fillers may be appropriate in soft atrophic scars of the rolling or boxcar type. HAF can improve the quality of overlying skin. Dermal fillers can be used either alone or in combinations with other procedures such as subcision, microneedling, ablative or fractional lasers, and peels. Although the use of dermal fillers is widespread, not much controlled studies have been published on their use in acne scars. Most data are from case reports and uncontrolled studies. The outcome and longevity of the tissue augmentation depend not only on the filler type and injection technique but also on the scar type. Best results have been obtained for rolling scars and depressed boxcar scars. In contrast, icepick scars and hypertrophic scars or acne keloids will not benefit from dermal filler injections at all. In practice, a multimodal approach seems to fulfill patient’s expectation at best.55,58

Fillers that can modulate ECM to reduce scarring seem to be the most interesting for future developments of a targeted treatment. Based on the experience with midfacial soft-tissue augmentation, targeted activation of white adipose tissue stem cells could be a prospective in filler use.59 Animal studies provide evidence that the combination of HA and stem cells leads to better and more stable results in tissue augmentation.60,61 This could be a step forward in tissue regeneration from which patients with acne scars may benefit in the future.

Author contributions

UW and AG conceived and designed the review, analyzed the data, wrote the first draft of the manuscript, agreed with the manuscript results and conclusions, jointly developed the structure and arguments for the article, and made critical revisions and approved final version. Both the authors reviewed and approved the final version of the manuscript for submission. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work.

Ethics

As a requirement of publication, authors have provided to the publisher signed confirmation of compliance with legal and ethical obligations including but not limited to the following: authorship and contributorship, conflicts of interest, privacy and confidentiality, and (where applicable) protection of human and animal research subjects.

The authors have read and confirmed their agreement with the ICMJE authorship and conflict of interest criteria. The authors have also confirmed that this article is unique and not under consideration or published in any other publication, and that they have permission from rights holders to reproduce any copyrighted material.

Disclosure

The authors report no conflicts of interest in this work.


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The skin reflects the state of health and age of a person. Even minor flaws are sometimes striking, and what can we say about scars (scars) – they obviously do not adorn a person, especially when they are located in places that are not usually hidden under clothing.

A scar is a piece of connective tissue that has replaced the damaged epidermis. For a woman, uneven skin is the cause of serious complexes, psychological discomfort and embarrassment, forcing her to put on a lot of makeup or resort to all sorts of tricks like bangs, glasses, closed clothes and swimsuits and other methods. Clean, beautiful, even skin is the best adornment for the stronger sex.

Removal of scars will be quick and painless if you use the services of our clinic. Modern laser technologies and the highest qualifications of doctors become the key to obtaining the desired result – smooth, intact skin, on which there are no flaws.

Scar removal at the S Class Clinic follows these important principles:

  • Use of innovative, high-tech laser equipment capable of handling even the most difficult tasks;
  • The cause and time of the appearance of scars does not matter, whether it is trauma, burns, surgery, frostbite, chronic inflammation;
  • Small scars will disappear, and large ones will become virtually invisible after contacting our specialists;
  • Recovery takes a short period of time, and the effect is noticeable very soon;
  • The tissues surrounding the scar are not damaged;
  • The laser promotes the production of its own elastin and collagen by the skin.

Scar removal

Laser scar removal is a completely safe procedure and does not require special training. However, it should be borne in mind that you will not be able to get rid of a very noticeable scar in one session. In order to make it practically invisible, you will need from 3 to 10 procedures, which can be performed with an interval of 1 month. Laser scar removal uses high-precision equipment that does not harm healthy tissues.However, the removal of scars still provides for a rehabilitation period, which can last up to 5-7 days.

By removing scars in this way, you can count on an excellent aesthetic effect, even when it comes to scars after burns or surgery. However, it should be remembered that laser scar removal has its own contraindications. These include various acute and chronic diseases, oncology, the presence of skin infections, diabetes mellitus and epilepsy. In addition, laser scar removal is contraindicated in women during pregnancy and lactation, as well as in people who develop keloid scars at the site of cuts.You should also refuse such a procedure if you have recently done a chemical peel or visited a solarium.

Before removing the scars, the cosmetologist of our clinic will conduct a careful and thorough examination, which will allow you to determine the laser operation program. Do not suffer and endure the inconvenience, contacting the S Class Clinic, you will return the skin on the face and body to a healthy look!

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Laser skin resurfacing is a deep peeling that gives a pronounced effect of renewal, rejuvenation of the epidermis surface.It removes scars, acne marks, pigmentation and wrinkles, as well as other aesthetic imperfections. In the STATUS re-age premium center for aesthetic medicine, laser resurfacing is performed on a modern UltraPulse laser (Lumenis, USA), which is considered the most powerful of medical CO 2 lasers.

Description of laser face resurfacing

The procedure in our clinic is carried out with mandatory local anesthesia. Under the influence of a directed laser beam, the thinnest upper layer of the skin in the desired area is completely evaporated: on the face, neck, in the décolleté or on the hands.This procedure really has a resurfacing effect on the skin – its surface is leveled, imperfections (scars, scars, acne marks, age spots, warts and even wrinkles) are removed completely or almost completely. The result is visible already after the first laser application! Complex scars or large, pigmented scars may require several sessions at intervals of several weeks.

Indications for laser skin resurfacing

  • Acne
  • Post-acne (pigmented and embossed marks on the face after acne)
  • Wrinkles (from small mimic to pronounced deep)
  • Scars, keloid and atrophic scars, burn marks
  • Enlarged pores
  • Pigmented spots
  • Vascular mesh (depth of occurrence – up to 4 mm)
  • Stretch marks

Contraindications

  • Age up to 18 years
  • Pregnancy and lactation
  • Cancer
  • Chronic and acute viral diseases
  • Photodermatitis
  • Heart problems
  • Epilepsy
  • Wounds or irritation at the site of exposure

Advantages of laser scar resurfacing with UltraPulse

This device provides the doctor with ample opportunities to effectively address various braids the patient’s mental problems.UltraPulse is the only ultra-pulsed fractional laser of its kind. It allows you to get the most pronounced result in one procedure with minimal risks of injury and complications.

Due to its high power and accuracy, as well as a set of replaceable nozzles and handles, the laser provides a quick procedure and comfort for the patient.

  • Efficiency of removal of scars, scars, post-acne, etc. The ability to combine deep and superficial effects within one procedure provides an unsurpassed result.
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  • A wide range of modes for working with various types of defects – from removing large scars to smoothing facial wrinkles.

Rehabilitation

The procedure for laser resurfacing of post-acne and other defects is minimally traumatic. Due to the use of the UltraPulse laser, the skin is minimally injured. The pulse energy of this device is 6 times higher than in other CO 2 lasers, so there is no need for reprocessing during one session, there is no additional effect on tissues.

Accordingly, the pace of patient rehabilitation is much higher. After the procedure, you can leave the clinic immediately. In the first few days after laser resurfacing of scars or wrinkles, you need to use special soothing cosmetics that your doctor will prescribe for you. Also, after the procedure, you should not often and often be in the open sun, visit the solarium and use decorative cosmetics.

It will be possible to evaluate the result of grinding in about 1-2 weeks.

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How effective is acne scar removal?

Today’s laser acne scar removal is much more effective than ever thanks to advances in laser technology. Patients can benefit from these treatments, which are aimed at treating existing acne, reducing scars, and even fading dark spots caused by acne.Laser treatments require less treatment time than other more traditional methods of removing acne scars, and can often achieve the desired results without leading to drug resistance.

Physicians often recommend laser treatments because of their long lasting effect and minimal recurrence of skin problems. While lasers differ in the areas they treat, they all use high-energy light to remove damaged skin. Doctors use a rod-shaped instrument to deliver laser light to areas of interest.The technology allows doctors to treat areas with high precision, which is important given the delicate nature of the facial skin. Laser treatments are also preferred over other skin resurfacing methods because they are relatively bloodless.

A carbon dioxide (CO2) laser emits a high energy laser beam into the epidermis or outer layer of the skin, destroying problem areas and revealing new tissue below. It was once one of the most common laser acne scar removal tools, but other methods have become more popular due to potential side effects.CO2 lasers have a higher risk of additional scarring or hypopigmentation and loss of skin color.

Erbium: YAG lasers are ablative lasers that also remove the outer layer of the skin to get rid of scar tissue. It produces energy at a wavelength that penetrates the skin and is very effective in removing scarring. The disadvantage of ablative lasers is that they require a longer recovery time than non-ablative lasers; in fact, laser-treated skin may remain red for several months after the procedure.

Fractionated lasers such as Fraxel® and Affirm® provide the effectiveness of ablative lasers by stimulating dermal changes without damaging the epidermis. However, many patients require multiple treatments to achieve the desired results. Scars are diminished as the target skin heals with the help of the surrounding untreated tissue.

Not everyone is a candidate for laser resurfacing. For example, people with psoriasis, cystic acne, and dermatitis may not respond well to this type of scar removal.