Acne (Pimples) Scar Treatment
Laser treatments are the fastest way to deal with scars and hyperpigmentation left behind when acne heals, but can also be beneficial for inflammatory acne. However, it’s not known to be particularly helpful for noninflammatory comedonal acne. The primary benefit of laser therapy, as well as the primary drawback of laser therapy, is that has very precise effects.
If you are squeamish about blood, chances are you will prefer laser treatments for acne to microdermabrasion. Laser treatments remove scars and pigmentation by heating hemoglobin in the blood in capillaries beneath the skin. Heating blood vessels deprive upper layers of skin of oxygen and nutrients so they slough off, giving new healthy skin a chance to replace them. The darker your skin, the less likely laser treatment is to be successful. The more sensitive your skin, the less likely laser treatment is to be successful. Laser therapy always requires multiple visits and never gets rid of 100% of scars or pigmentation. A program of regular skin treatments such as Exposed Skin Care may complete the job started by laser therapy, at much lower cost.
Understanding Acne Scars and How they Form
Acne happens when pores in the skin fill up with dead skin cells, oil, and bacteria. They then eventually become inflamed and burst. When this happens deep within the skin, all that infected gunk spreads among the deeper tissues, resulting in even bigger lesions.
Your body will create collagen to try to repair the damage, which ends up changing the smoothness and the texture of your skin. This could mean depressions and indentations on the skin or excess skin forming. Basically, there are two types of scars: hypertrophic and atrophic.
Hypertrophic – This type of acne scar happens when too much collagen is produced and results in skin bumps, flaps of skin or ridge-like areas on the skin.
Atrophic – This type is the opposite, the tissue is lost during the healing process, resulting in depressions in the skin. Ice pick and boxcar scars are in this category.
Acne occurs when skin pores become filled with oil, dead skin cells and bacteria. The pores become inflamed and eventually burst. If the pore wall bursts deeper in the skin, the infected debris leaks into the deep tissues, which creates larger lesions.
How Laser Skin Treatments Work
Lasers produce intense monochromatic light, light that is limited to a very a narrow band of wavelengths. This light has no effect on some substances and high-intensity effects on others. One setting might heat hemoglobin but have no effect on neighboring skin cells. Another set might “melt” the melanin that causes deep pigmentation on the skin. A third might vaporize tattoo ink. Dermatologists use lasers to destroy specific substances at specific depths in the skin.
The primary effects of laser light in skin resurfacing are photothermal, heating a particular substance in the skin. The process of using the laser to remove blemishes on the skin is known as photothermolysis, the breakdown of selected tissues in the skin. Continuous laser light would destroy tissues surrounding the target as the target tissue heated, so laser skin treatment is usually done with pulsed lasers.
Continuing Improvements in Technique
Laser therapy for acne scars and brown spots first arrived in dermatologists’ offices about 1980. The early continuous wave neodymium:yttrium-aluminum-garnet (Nd: YAG) laser was used to heat the basal cell layer underneath the skin to stop collagen production. Tissue above the treated layer of the skin charred and sloughed off, initially growing back without scars or pigmentation. Scars always returned, however, about a year after treatment with this early kind of laser.
In the early 1990’s, doctors were introduced to the vascular-specific 585-nm pulsed dye laser (PDL). Treatment with PDL was targeted on hemoglobin. The topmost layers of the skin were unaffected by the laser. Only the hemoglobin in the blood underneath them was heated. Pulsing the laser kept skin above blood vessels from charring. This technique proved to be very effective for removing port-wine and purple skin discoloration, and also acne scars.
The third type of laser treatment, carbon dioxide laser ablation, could be used to remove overgrowth of skin tissue lying on top of scars.
Doctors discovered that the key to getting lasting results from laser therapy was to make sure the immune system did not send white blood cells to “eat” dead skin tissue. Accumulations of the clean-up cells known as macrophages could cause scars to form all over again. Laser treatments were followed by treatment with steroid creams to prevent swelling and malformation of new skin.
The Pluses and Minuses of Acne Laser Treatments
The tremendous advantage of acne laser treatments over earlier techniques of scar removal was that it was bloodless. Dermabrasion involved mechanically stripping off just the top 25 layers of skin cells down to the “quick,” where blood vessels were found. Regenerative skin cells underneath this layer could then rise to fill in the scar as they replaced the skin.
Dermabrasion left a bloody wound that could easily be infected. Laser treatment, however, worked from the inside out without bleeding and with much lower risk of infection.
The downside of laser treatments for acne has always been that one treatment is never enough to remove a scar. And certain skin types just do not respond very well to laser treatment.
The darker the skin, the more melanin there is to absorb some of the light energy intended for hemoglobin. Skin above the level of the capillaries serving the skin can char and leave an open wound. When the skin grows back, it may be lighter than surrounding skin. The darker the skin, the greater the problem with loss of pigmentation after treatment.
Another problem in laser treatment of black and dark brown skin is that darker skin tends to form tough scars known as keloids. These disfigurements require more treatment than ordinary acne scars, running greater risk of damage to the skin. About 1 in 6 people with black skin and acne will develop keloids that cannot be treated with laser, compared to about in in 20 people with white or Asian skin and acne.
Should You Have Laser Treatment for Acne?
Even if you have fair skin, there are reasons you may not want to have laser acne treatment.
Laser treatment for acne is expensive, and not typically not covered by insurance. Each session may cost up to US $1000 and as many as 10 sessions may be needed. Raised acne scars eventually smooth themselves out, although this may take several years. If you have used Retin-A, Renova, or tretinoin topical, your skin may be thin underneath indented acne scars. It’s important to wait at least six months after using any of these products before having laser acne procedures. Contact dermatitis, eczema, and psoriasis are worsened by laser treatments. Also, as mentioned at the beginning of this article, laser treatments are very precise. There may be a noticeable difference between treated and untreated areas of skin, almost as if a line had been drawn across your face. Laser treatment is not the final answer for acne. It is possible that if you express the expectation that laser treatment will remove 100% of your acne, chances are that your dermatologist will reject you as a patient for this procedure because of unrealistic expectations. Laser acne treatments improve the skin, but they never perfect it.