Acne Scar Laser Versus Fraxel Versus Procedures Versus Ointment How Effective Are They

Unlike in the past, when acne was considered a symbol of puberty, it has recently become a common skin concern for adults in their 30s and 40s. While acne itself is a problem, the scars it leaves behind can cause stress for even longer. Let's explore common questions about acne and acne scar treatment with a specialist from Yonsei Star Dermatology Sinchon.

In the past, it was common to treat acne sufficiently before treating scars. However, acne often lasts longer than expected, and recent reports suggest that concurrent treatment of acne and acne scars is more effective when they appear together. This is because certain scar treatments can also help reduce acne breakouts. A combination of medication and acne-effective lasers (e.g., non-ablative lasers) may help improve both acne and scars simultaneously. However, it is important to combine the two treatments, as focusing solely on scar treatment could worsen acne.

Characteristics of Adult Acne: Jawline Acne

Acne on the jawline is primarily a characteristic of adult acne. During puberty, sebaceous glands on the forehead and nose react sensitively to hormones, causing acne. However, with age, sebaceous glands in the U-zone, such as the jawline, react, leading to acne. Stress is also known as one of the main causes of jawline acne. Jawline acne can be inflammatory and red, or it can appear as comedones (whiteheads). It is especially important to be careful with comedones on the jaw or neck, as they are difficult to extract at home and can leave scars. Additionally, acne that has passed unnoticed may be papular acne scars that remain as hypertrophic scars.

Back and Chest Acne: Early Treatment is Important

Acne on the back or chest (back acne, chest acne) is most effectively and cost-efficiently treated with medication. If medication is difficult to take or scars are already present, laser treatment may be considered. Recently approved medications like Aklief are effective for back and chest acne. In severe cases of acne, antibiotics or sebum-regulating medications may be necessary. Acne on the back or chest is prone to leaving scars, which can be unsightly, especially for women wearing low-cut dresses. Since it is difficult to treat in a short period, it is advisable to reduce it in advance through medication or laser treatment.

Subcision: Is bleeding okay?

Many people worry about bleeding during Subcision. However, this is naturally absorbed by the body, just like a bruise, and is not harmful to the skin. In fact, a skilled physician can control the amount of blood and the depth it rises to enhance the treatment effect. While textbooks only describe one technique, experienced physicians utilize various methods such as:

• Controlling blood volume: Appropriately adjusting to prevent a large amount of blood from rising at once.
• Combining with other treatments: Combining with other treatments at weekly intervals to prevent excessive bleeding and enhance the treatment effect.
• Combining with lasers: There is also a technique to maximize the treatment effect by irradiating the blood in the treated area with a laser after Subcision, causing it to react with the blood.

Fractional vs. Ultra Laser: Comparing Pain and Efficacy

Laser treatments vary in pain intensity depending on the type. Fraxel DUAL laser, which applies heat inside the skin, tends to cause more significant pain. Some patients have reported that the pain increased with more sessions, to the point of tearing up.

In contrast, Ultrapulse Alpha laser, which treats by ablating the skin, is known to be less painful than Fraxel DUAL. One study reported that Ultrapulse Alpha laser was about 5 times more effective in improving acne scars than Fraxel DUAL-type lasers. However, Ultrapulse Alpha laser has the disadvantage of requiring dressing for about 2-7 days, depending on the intensity.

Acne scars vary in shape and characteristics, so customized treatment tailored to the individual's scar type is important.

Differences Between Enlarged Pores and Atrophic Scars

Enlarged pores that appear at a young age are primarily due to enlarged sebaceous glands producing more sebum, leading to wider pores. Treatment focuses on reducing sebum by taking medication to shrink sebaceous glands or using lasers that destroy sebaceous glands (e.g., 1320nm laser).

Atrophic scars are deep scars with narrow openings, typically 1-2mm in size. Unlike enlarged pores, their narrow openings make it difficult for lasers to penetrate effectively.

Key Treatments for Acne Scars and Atrophic Scars

• Scar Fillers: For round scars where Subcision is burdensome or bruising is undesirable, scar fillers can be used to fill and raise the scars. Circular scars of about 6mm can show significant improvement with just one treatment.
• TCA CROSS: This is an effective standard treatment for deep atrophic scars with narrow openings. It involves applying a specific chemical only to the affected area and is known to have originated in Korea.
• Punch Excision: Applied to small circular or deep atrophic scars to lift the scar or match it with the surrounding skin.
• Combined Laser Treatment: Various lasers are used in combination to enhance efficacy depending on the type of scar. Methods that achieve similar effects to TCA CROSS using lasers have also been developed.
• Long-term Treatment Plan: Occasionally, after laser treatment or TCA peeling, some may feel that their scars have slightly widened. This can occur during the process of refining the borders, but ultimately, the scars become shallower and improve. Therefore, it is advisable to establish a long-term treatment plan of about one year rather than being overly concerned about short-term changes.

In acne treatment, medication is one of the most cost-effective methods. Various medications are used depending on whether the acne is inflammatory and the individual's skin condition.

Characteristics and Effects of Key Acne Ointments

• Isotretinoin (Sebum Regulator): Skin dryness may occur when taking this medication, which can be seen as a sign that the drug's effect is beginning to manifest. It is recommended to use plenty of lip balm, petroleum jelly, artificial tears, and moisturizers on dry areas such as the lips, nose, and around the eyes. The effect usually begins to be felt after one week, and consistent use for more than a month is necessary to see full results.
• Cleocin (Antibiotic Component): Effective for red inflammatory acne, and its effect appears relatively quickly compared to other products.
• Nadixa (Antibiotic Component): An antibiotic ointment that is less irritating and has a smoother feel than Cleocin. Antibiotic ointments like Cleocin or Nadixa are effective depending on whether the acne is inflammatory.
• Stieva-A (Vitamin A Derivative): Can help not only with acne treatment but also with preventing skin aging. Initially, start by applying it to the forehead and gradually extend to wider areas. If severe dryness or peeling occurs, discontinue use or adjust the dosage by mixing it with moisturizer. More potent and less side-effect-prone medications like Differin and Aklief have also been developed. To reduce antibiotic resistance issues, medications like Duac, which combine vitamin A derivatives or two ingredients, are also used instead of antibiotics alone.

Noscarina Ointment: Scar Improvement Effect?

Noscarina ointment may have some effect on scar prevention and early scars (within 6 months), but its scar improvement effect is known to be less than 10%. Therefore, rather than focusing on improving existing acne scars, it is much more important to actively treat acne early to prevent scars from forming when it occurs.

Is there really a correlation between acne-triggering foods?

The correlation between food and acne is not 100% clearly established, but recent studies have reported some associations.

• Foods that rapidly raise blood sugar: Foods that quickly raise blood sugar, such as chocolate, can promote insulin secretion and may worsen acne, according to some reports.
• Dairy products: Some studies suggest that dairy products may not be good for acne. However, milk also has many health benefits, so if you tend to experience worsening acne after consumption, it is advisable to adjust your intake.
• Greasy foods: There are also claims that greasy foods cause acne, but this varies greatly from person to person and does not apply to everyone.

In conclusion, rather than unconditionally avoiding specific foods, it is important to maintain a balanced diet while observing your body's condition.

The Core of Oily Skin Care: Maintaining Balance

For oily skin and acne, people often over-cleanse or exfoliate excessively to remove oil. However, this can actually dry out the skin and worsen acne. It is fine to use various soaps, including Dove soap, but the important thing is to achieve a balance where the skin does not feel oily but has a slight dryness. Excessive dryness leading to flaking or tightness indicates over-cleansing or over-care. If you have dry skin but still experience acne, it may be necessary to use moisturizers to reduce flaking. If oiliness and dryness vary across different areas of your face, using products for oily skin on oily areas and moisturizers on dry areas is a wise way to balance your skin. Additionally, stress is considered the root of all diseases and affects acne, so stress management is important.