Treatment of acne scars

Acne scars – why do they form?

Acne scars are usually a complication of inflammation occurring in the sebaceous glands of the skin, which include the papules and pustules that occur in the course of acne. Large inflammation and accompanying swelling or manipulation by the Patient who scratches or squeezes the lesion can cause the sebaceous gland wall to rupture. If a deep rupture occurs in the gland wall, the infected contents of the gland can affect the surrounding tissue, creating extensive lesions. The skin’s natural regenerative abilities mean that new collagen fibers are produced to repair the damage done to the tissues, but even so, scarring is very often the consequence.

Types of acne scars

There are two basic types of acne scars: atrophic and hypertrophic. The vast majority of people with acne scars have atrophic scars, which occur when collagen is lost at the site of skin tissue damage and characteristic depressions form on the skin’s surface. Hypertrophic acne scars are much less common and are the result of a situation in which the natural repair processes in the skin damaged by acne lesions are too intensive, and the skin produces too much collagen. Continued production of collagen often results in significant growth of the lesion, which becomes convex and extends above the skin surface.

Traditional treatments for atrophic acne scars

Treatments to improve the appearance and make acne scars more shallow depend on their severity. In some cases, chemical peels or microdermabrasion can help improve the appearance of small scars. In the case of deeper atrophic scars, several types of treatment may be applied, but one of the more commonly recommended therapies is the so-called skin resurfacing, i.e. renewal of the skin surface with a CO2 laser using fractional techniques, which involves the creation of micro-damages in the skin, which by healing give the effect of regenerated, smoothed out complexion and shallowing of the depth of scars.

While peels, microdermabrasion, and laser skin resurfacing are considered effective treatments, they often require multiple sessions, and the post-treatment healing period usually takes 3 to 14 days. Furthermore, for dark skin phototypes, the risk of adverse side effects, such as the appearance of post-inflammatory hyperpigmentation (PIH), is high and often forces operators to use reduced treatment parameters that limit the potential benefits of treatment.

Discovery Pico Plus Laser – a breakthrough in the treatment of acne scars

A new therapeutic approach for the treatment of acne scars based on the fractionated picosecond laser DISCOVERY PICO PLUS has become increasingly common due to its excellent clinical results and extremely low risk of PIH.

The Discovery Pico Plus 1064 fractional head laser effectively stimulates collagen formation and skin remodeling resulting in a shallower scar, improved appearance and smoother skin surface. The treatment can be performed on all types of atrophic acne scars, whether ice pick, rolling, box car or mixed. Numerous studies have shown that Discovery Pico Plus proves well on scars that are described as mild to moderate in severity.

The procedure requires minimal preparation and the skin healing time is very short. Laser Discovery Pico Plus can be used for Patients for whom ablative or non-ablative fractional lasers have shown less efficacy in treating acne scars.

Procedure of acne scars treatment with Discovery Pico Plus laser

Each treatment with the Discovery Pico Plus laser is preceded by a medical interview, during which contraindications to its performance are excluded. Before the procedure, local anesthesia with lidocaine cream is applied for 30 to 50 minutes. Each Patient during the treatment of acne scars with fractional head 1064 nm receives about 2000 shots covering the skin of the entire face. This is followed by two laser sweeps in the areas where the acne scars are located. The expected effect of performing additional laser sweeps is to produce pinpoint bleeding. The full procedure usually takes about 15 minutes.

After the procedure, Patients are advised to avoid sun exposure and use broad-spectrum sunscreen on the entire face. The skin healing period lasts from 3 to 8 days, depending on the level of energy used and the number of laser sweeps. After the treatment erythema of the skin appears, which usually disappears after 24 hours, leaving brownish scabs. These crusts peel off within 3 to 4 days.

It is recommended that 6 treatments be performed at 4-week intervals. Scar remodeling continues 6 months after the last treatment. To increase the effectiveness of treatments, dermatologist Marcin Zakrzewski, MD, PhD recommends using the ZO Skin Health protocol with retinol.

Effects of treatment

The effect of the treatment is shallowing of scars, improvement of their appearance and smoothing of the skin surface. After the treatment Patients also notice the effect of reducing the size of pores and depth of fine wrinkles in the periorbital region. In addition, facial skin is brightened and its tone is evened.

Patients did not report any adverse side effects after the procedures performed at the Zakrzewski Clinic. A few Patients complained of slow resolution of subcutaneous petechiae. The occurrence of increased skin sensitivity and the appearance of PIH post-inflammatory hyperpigmentation were not reported.

Discovery Pico Plus laser technology for the treatment of acne scars

Handle with an array of fractional microlenses was used to concentrate the laser energy into small dots about 200 micrometers in diameter. Within each of these points, the fluence can reach very high doses capable of producing vacuoles in the epidermis and dermis, generated by the photoacoustic interaction of the picosecond laser beam with blood vessels, melanin and dermal collagen. The 1064 nm Frax head covers approximately 5% of the skin with each shot. It provides an average fluence of 0.1 to 1.4 J / cm2.
Frax 1064 nm head focuses microbeams in the dermis, minimizing the formation of laser-induced plasma on the skin surface. With the Frax 1064 n head, vacuolization occurs in the epidermis and dermis. The vacuole in the epidermis is correlated with the inflow of the laser beam. However, laser-induced optical degradation of LIOB occurs only in the dermis, and the vacuoles are very small in size. For any living tissue, vacuole collapse may occur immediately after treatment due to the onset of wound healing. However, visible changes involving the degradation of old collagen fibers are characteristic. The structural change in collagen fibers then stimulates remodeling of the extracellular matrix of connective tissue, resulting in the desired scar remodeling effect.

In conclusion, the 1064 nm FRAX tip replaces most ablative or non-ablative fractionated devices used in the treatment of acne scars due to its excellent clinical results, short healing time and lack of PIH.

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