Special considerations need to be taken into account when treating darker skin types, namely the BIOLOGY & physiology of SOC (Skin of colour). Darker one is, the more vigorous the response to pigmentation as well as unwanted scarring (keloid, hypertrophic scars).
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Manual revision is the basis of acne scar management. Devices should only be used as tools, if & when necessary. For an average case of acne scar case, I spend over 90% of my time with manual methods such as subcision & peels, & only 10% of time on devices such as lasers - RF microneedling. Devices are relatively straightforward- step on a pedal or press a button, you just need to know what to use & when to use. Of course have the CORRECT equipment will make revision more efficient, & also safer.
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Science: All things being equal (procedure, skill level, equipment level) the end result in the context of scar revision is largely based upon one’s ability to remodel scar tissue & regenerate dermal matrix. Everyone lies on a bell curve. Subcision beaks attached scars in the dermis but mostly the hypodermis. Fillers give a helping hand to severe atrophy or those who lie to the left of the curve.
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Scar types: Superficial acne scars include boxcar scars, pick scars, isolated icepickscars, & mild rolling scars. These can be treated with the usual microneedling, lasers, RFmicroneedling, TCA, & phenol peels, those scars respond predictably to treatment. Applying the correct parameters will reduce but not eliminate PIH or paradoxical skin darkening.
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Deep Scars include rolling scars, atrophic scars & tethered acne scars. With significant atrophy, in some cases your immune system can not stimulate enough collagen (& or adipose tissue) to replace the divots & undulations, namely rolling + atrophic scars. We can use many techniques to ASSIST YOUR IMMUNE SYSTEM such as energy devices & manual methods
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Subcision is important, the needle technique is outdated, cannula, modified instrumentation subcision or NOKOR blades yield much better results. Pros & cons or each to be discussed with your #dermatologist or plastic surgeon
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Control of background acne: Is vital to good outcomes, ANY background inflammation can distract the immune system to repair scars, if one has 5 pimples per month & only ONE scar, over a course of 4 years there will be nearly 100 NEW SCARS. Control must be absolute in those who have the propensity to scar. This point is also the rate limiting factor in the majority of scar revision procedures. Even if one has a handful of active lesions, this can dramatically hamper the course of effective & efficient scar revision. Please have your acne in absolute remission prior to, or very very early in the course of scar revision.
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Dr Davin Lim
Brisbane
@cliniccutis @drdavinlim
#acnescars #acnescartreatments

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