Stubborn Severe Acne Scars When Nothing Else Works Try Laser Skin Resurfacing

Acne primarily affects adolescents and young adults in their 20s, and recently, there has been an increasing trend in those aged 30-40s. It is known that about 1% of men and 5% of women continue to experience acne even after the age of 40. While acne itself is a problem, the scars left behind after acne do not easily disappear once formed. In particular, 95% of people who have suffered from acne for more than 3 years develop acne scars, which can become a source of lifelong stress.

Acne scars vary widely in shape, color, and depth from patient to patient, making treatment very challenging. Therefore, dermatologists are making great efforts to find effective treatment methods.

Acne scars can be broadly divided into depressed scars (atrophic scars) and raised scars (hypertrophic scars). Raised scars mainly occur on the chin or chest, and in severe cases, can develop into keloid scars. Depressed scars, which primarily appear on the face, are classified into three types based on their shape.

Three Main Forms of Depressed Scars

• Icepick scars: V-shaped, short, and deep scars, often with an opening of less than 2mm.
• Rolling scars: Round-shaped scars that appear wavy and uneven.
• Boxcar scars: Square-shaped scars resembling train freight cars.

The reason for classifying scar shapes in this way is that the treatment method may vary for each type of scar.

Classification of Acne Scar Severity

The severity of acne scars can be divided into 4 stages based on their impact on interpersonal relationships.

• Macular scars: Scars with a flat surface and only a change in color (red, brown, white, etc.). Early and aggressive treatment can prevent the scars from deepening.
• Mild scars: Scars that are not clearly visible from a distance of 50cm and can be easily covered with makeup.
• Moderate scars: Scars that are clearly visible from a distance of 50cm or more, but are soft and flatten when the skin is stretched.
• Severe scars: Scars that are clearly visible from a distance of 50cm, difficult to cover with makeup, and hard, not flattening even when the skin is stretched.

Laser resurfacing is a treatment that deeply irradiates the skin with a laser to match the height of the depressed areas with the normal areas, and induces a secondary wound response in the sunken areas below to promote skin regeneration. It plays a role in flattening uneven skin. The advantage of laser resurfacing is that it lowers raised areas and fills in sunken areas.

When is the appropriate time for treatment?

It is best to treat when acne no longer appears and only scars remain. This is because performing the procedure while acne is present can worsen the acne. However, if there is only a small amount of acne compared to the past, the procedure can be performed in conjunction with medication.

Treatment Area and Frequency

Laser resurfacing can be performed on the entire face, or partially on areas with deep and severe scars such as the cheeks or temples. The cheek area, in particular, is known to regenerate well and has a fat layer, making it effective. While multiple treatments are possible, a significant advantage is that satisfactory results can often be expected with just one treatment compared to other lasers. It is recommended to perform treatments at intervals of one month or more.

Effectiveness Verified Through Clinical Research

According to a 2014 study, 22 patients underwent one session of laser resurfacing, and 12 patients (51%) showed more than 75% improvement, while 7 patients showed 51% to 75% improvement. Most patients showed more than 50% improvement with a single treatment.

Applicable to Various Scar Shapes

Since laser resurfacing is a method of abrading the skin, it can be applied to scars of any shape and depth, such as icepick, rolling, and boxcar scars. However, the procedure may be limited for very thin skin as it cannot be indiscriminately abraded. It is known that for deep and severe scars, effective treatments like laser resurfacing are rare.

Laser Equipment Used

Erbium YAG lasers or Ultrapulse CO2 lasers are mainly used for laser resurfacing. In particular, CO2 lasers can generate a lot of heat in the skin, potentially causing secondary scars. Therefore, Ultrapulse equipment, which can precisely irradiate high energy in a short time, is primarily utilized.

While laser resurfacing is highly effective, it has the disadvantage of a longer downtime compared to other procedures. Wet dressing is required for about a week after the procedure, and temporary erythema and redness may appear as new skin grows. There is also a possibility of slight pigmentation occurring after about a month. Due to these inconveniences, other treatment methods may be considered for less severe acne scars.

Precautions After the Procedure

• Temporary Erythema and Redness: The treated area may become red, which will gradually improve over time.
• Hyperpigmentation/Hypopigmentation: Temporary pigmentation may appear, but it usually improves over time.
• Temporary Worsening of Acne: If acne is present, it may temporarily worsen, so it is recommended to combine with medication.
• Oozing and Dressing: Oozing may occur for 2-3 days after the procedure, and dressing is required for about a week. For office workers, it is advisable to use vacation time.
• Sun Protection: Since the skin may become red and pigmented after the procedure, special attention must be paid to sun protection.

In addition to laser resurfacing, there are various procedural methods for treating severe acne scars. Appropriate treatment can be selected based on the characteristics of each scar.

Subcision

This procedure involves inserting a needle under the epidermis and dermis of the skin to break the fibrous bands that pull the scar downwards. Blood accumulates in the broken area, pushing the skin upwards and flattening the scar. It is mainly effective for widely depressed scars like rolling scars.

• Advantages: Provides an immediate lifting effect on scars.
• Disadvantages: Bruising may occur in the treated area for about a week.

Punch Excision/Grafting

This procedure uses a round punch tool to excise the scar area, then lifts the tissue upwards or grafts normal skin tissue from another area and sutures it. It is mainly effective for deep, round-shaped scars like icepick scars or boxcar scars.

• Advantages: More effective for deeper scars than lasers, and immediate improvement can be expected.
• Disadvantages: It is a manual process, so the procedure takes a long time and is only applicable to cylindrical scars.

Scar Filler

This procedure involves injecting fillers, typically used for wrinkle treatment, into depressed acne scars to fill in the sunken tissue. It is mainly effective for rolling scars, and similar to Subcision, immediate effects can be expected.

• Advantages: Provides immediate results and has relatively fewer side effects as bruising is less common.
• Disadvantages: Some may have an aversion to using external substances. (In such cases, treatment using autologous blood can also be considered.)

Currently, there is no perfect method to erase severe acne scars like an eraser. However, through laser treatment or procedures, significant improvement can be achieved to the extent that it does not greatly interfere with interpersonal relationships. (Our goal is an improvement where scars are not a major concern from a distance of about 50cm.)

Since acne scars vary in shape and depth, combining laser resurfacing with various procedural treatments such as Subcision, Scar Filler, and Punch Excision/Grafting can yield more satisfactory results. While laser resurfacing requires a recovery period of about a week, it is known as a treatment that can provide superior results compared to conventional fractional lasers.