Acne Scars

Model (Courtesy of Dr. Adam Baker, MD)

Acne scars are very common and of great concern because they can give a disfigured appearance. These scars are usually formed when pimples are popped; this release of the pus into the skin leads to an inflammatory reaction in which abnormal collagen is generated and the skin does not heal properly. The depressions that are left in the skin are called atrophic scars. It is important to differentiate these acne scars with the discoloration that can occur after blemishes (called post-inflammatory hyperpigmentation) because the treatment is different. The deeper the scars, the more aggressive the treatment required. There are multiple ways to address these scars. I recommend starting with a good skin care regimen with a retinoid, exfoliant, antioxidant, and sunscreen. After several weeks of pre-treatment procedures such as chemical peels and laser treatments may be performed. Fractional ablative lasers, especially when combining them with other procedures as in the A E Skin Ultimate Rejuvenation, can give outstanding results with minimal downtime. A series of three treatments is generally recommended at four to six week intervals. More may be done depending on the severity and response. Women who are pregnant or breast feeding should not be treated.

Topical Numbing Cream

Topical numbing cream is used to provide comfort for a variety of cosmetic procedures such as injectables and laser procedures. There are a variety of different formulations and the most common ingredient is lidocaine. This is the same anesthetic dentists use when doing procedures. Applying the cream topically to the skin is easy and does not require a needle. It is usually applied anywhere from 15 minutes to one hour before to a treatment and cleaned off with water immediately prior to the procedure. Some of the injectable products such as Juvederm Ultra XC contain a numbing ingredient for added comfort. Topical numbing cream should always be applied in a medical office and never by patients at home. The reason is that the ingredients can be absorbed into the bloodstream and cause adverse effects. There have been cases where people have been hospitalized and even died because they applied too much topical numbing cream prior to the procedure. Although these situations are rare, it is important that the numbing cream is applied by in an office to avoid complications. When used appropriately topical numbing cream application is a safe and easy method of providing comfort during procedures.

What is Microdermabrasion?

Microdermabrasion is a simple procedure usually performed by an aesthetician used to remove a thin layer of dead skin cells from the surface of the skin. Removing the dead skin cells lead to a number of improvements in the skin including improvements in both discolorations as well as textural changes such as fine lines, wrinkles, and shallow scars. It also allows skin care products to be absorbed more effectively for improved results and makes makeup easier to apply. Men notice a closer shave after microdermabrasion treatments.

Unlike chemical peels or laser resurfacing, microdermabrasion is a very superficial treatment. The advantage is that there is minimal downtime; for example redness may persist for only a few hours. The disadvantage is that more treatments are required for best results. Treatments are typically done at one to two week intervals.

Traditional microdermabrasion uses fine crystals sprayed on the skin combined with a vacuum that immediately removes the crystals. This is very similar to using sandpaper on the surface of furniture to smooth it out. The depth of penetration can be adjusted by changing the size of the crystal, by adjusting the speed of the crystal flow, and by increasing or decreasing the number of passes applied to the skin. Some new technologies contain a diamond and do not use crystals, which improves comfort during the procedure.

After a microdermabrasion treatment the skin will be sensitive and likely red. Do not apply makeup for several hours after the treatment. It is important to use plenty of moisturizer because the barrier function of the skin changes after the surface layer is removed. Always be sure to use a broad spectrum sunscreen with a minimum SPF of 30 to protect against sun damage.

Post Inflammatory Hyperpigmentation

Post inflammatory hyperpigmentation (PIH) is a term used to describe the dark discoloration that can occur on the skin after a variety of cosmetic (or other) treatments such as laser procedures, chemical peels, and injections. PIH can also occur after other things such as cuts, burns, and sun exposure.

It is important to understand the difference between PIH and scarring, as they are commonly confused. PIH is a pigment change in the skin caused by certain cells called melanocytes. Scarring, on the other hand, is the formation of abnormal collagen in the skin. When touching a scar, you can feel an elevation or depression in the skin or a difference in the texture. This is not the case for PIH, where the skin remains flat and smooth. The reason to differentiate scarring and PIH is because the treatments are different.

PIH tends to occur on those with darker skin, namely those with Fitzpatrick skin types IV - VI. These skin types are common in certain groups such as Africans, African-Americans, Hispanics, Asians, Middle Easterners, and Mediterraneans. For this reason it is recommended that these people start a skin care regimen for several weeks prior to cosmetic treatments to minimize the risk of PIH. Recommended skin care products include brightening creams, exfoliants, antioxidants, and sunscreens. Without pre-treatment the risk for PIH is higher.

Fortunately PIH is temporary and treatable. It will usually go away on its own and the length of time it takes for this varies from person to person but can range anywhere from one week to over one year. Treatment for PIH includes a skin care regimen with brightening creams to lighten the discoloration. These products usually include ingredients such as hydroquinone (the strongest), kojic acid, alpha-arbutin, azeleic acid, and licorice extract. Sunscreen use with SPF at least 30 with UVA and UVB protection is mandatory to prevent the discoloration from becoming worse. Retinoids, antioxidants, and other products may be added for further benefit. Treatments such as photofacials, fractional lasers, and chemical peels may also help. The best way to treat PIH is by preventing it in the first place; this means knowing your Fitzpatrick skin type and getting on a good skin care regimen for several weeks prior to cosmetic treatments.