T here is little question that severe acne scarring can be a debilitating condition for sufferers. Even mild acne scarring can drastically alter a patient’s self-esteem and confidence. Fortunately for these patients, there are a number of very effective treatment options that can produce dramatic improvements in the appearance of the various types of acne scars. In general, you can achieve a 40% to 50% improvement in a scar’s appearance, which most patients gauge as a huge success. Treatment Options Exciting new technologies, including the fractional laser, can now be used on patients of all skin type to produce significant improvements with minimal risk and virtually no downtime for the patient. “What I think is important for doctors to realize is that the old conventional wisdom that you cannot treat people of color for conditions like acne scars no longer holds true,” says Roy Geronemus, M.D., Director of the Laser & Skin Surgery Center of New York. “The newer techniques, especially the fractional laser, can dramatically improve the look of all acne scars in patients of any skin type with little risk to the patient.” According to Jeffrey Dover, M.D., Director of SkinCare Physicians of Chestnut Hill and Associate Clinical Professor of Dermatology, Section of Dermatologic Surgery and Oncology, Yale University School of Medicine, and Adjunct Professor of Medicine (Dermatology) at Dartmouth Medical School, there are three primary light-based technologies that are highly effective in treating acne scars: 1. laser resurfacing 2. fractional laser resurfacing 3. non-ablative skin rejuvenation using a near infrared laser. All of the techniques work well with varying levels of side effects, downtime and cost. “My acne scar patients are my favorite patients because they are all so very happy with the improvements that we can make,” says Dr. Dover. “For me, it is very rewarding to have someone tell me that what I did for them changed their lives.” Laser resurfacing uses a CO2 laser to vaporize the upper layers of the skin. The ultrapulsed carbon dioxide laser, erbium YAG laser and the pulsed dye yellow light laser are most frequently used in laser resurfacing. The technique is highly effective in improving the appearance of the skin. However, it cannot be used with all skin types and the patient has to endure significant discomfort, side effects and down time. “Without question, laser resurfacing gives the best results. However it is the most involved and as a result, lots of patients who are good candidates don’t do it,” says Dr. Dover. “But, when patients come in and say they want the best possible improvements and can deal with the downtime that is our choice.” The fractional laser Fraxel SR system from Reliant Technologies uses a 1550 nm diode pumped erbium fiber laser delivered through an optically tracked microprocessor controlled handpiece to produce an array of tiny thermal zones, each about 100 microns in diameter and 400 to 700 microns deep. This produces epidermal necrosis and collagen denaturation, which is very well tolerated as long as the spacing of the zones is more than twice the diameter of the zone itself, or about 200 microns. The stratum corneum is generally not damaged because its low water content reduces absorption of laser energy. The epidermis heals within 24 hours after keratinocytes migrate into the defect. Fractional laser resurfacing offers the benefits of speedy healing and virtually no downtime. Side effects are minimal, typically limited to swelling and redness with no oozing or crusting. Mild swelling should subside within a day or so, and the redness usually fades over several days. Patients can apply make-up immediately after treatment and return to routine activities. There is limited, if any, risk of infection or scarring. “Fractional laser resurfacing is a nice addition to the toolkit. It gives very good results without the serious down time of laser resurfacing. You need to apply some type of topical anesthesia prior to starting the procedure and forced-air cooling during treatment,” says Dr. Geronemus. “We typically do five treatments, though you can continue to see improvements with additional treatments. We generally do two treatments a month, but in some cases if we’re doing aggressive treatment, we might do one a week. After the treatment, we typically see nothing more than a little swelling or redness.” Dr. Geronemus explains that each treatment session with the fractional laser takes about 10 to 15 minutes. Dr Geronemus estimates that he treats about 90% of his acne scar patients with the Fraxel laser. Often, he combines fractional treatment with other non-ablative treatments to improve results in certain patients. His other patients are treated with other techniques for a variety of reasons, including that some patients do not want to pay for the additional cost of the fractional laser treatment, which may be up to 50% more than other non-ablative techniques. In other cases, some patients are reluctant to use a new technology and would rather be treated with a technology that has a longer track record. Non-ablative laser skin rejuvenation, using near infrared lasers such as the CoolTouch (1320 nm), SmoothBeam (1450 nm) and Aramis (1540 nm), also offer effective treatment. “We use all three and have had good results with all of them,” explains Dr. Dover. “The real advantage is the limited downtime, primarily redness for a few days,” he adds. “With the SmoothBeam and CoolTouch, we use topical anesthesia, topical 5% lidocaine cream (ELA-Max) for an hour before treatment,” explains Dr. Dover. “The Aramis is less painful so we can avoid the anesthesia, but it takes longer to do since the spot is smaller. However, the total time for treatment is often less since we’re not waiting for the topical anesthesia to take effect. It can also be cheaper to use the Aramis since the ELA-max is quite expensive.” Preparing Patients for What to Expect Since none of the treatments will completely eliminate the acne scarring, it’s very important that the physician explain to the patient what to expect. This setting of expectation levels will have a real impact on how the patient perceives the relative success of the procedure. “I have had a few patients walk out after I explained that I could not eliminate their scarring completely,” says Dr. Geronemus. “On the other hand, many of my patients are pleasantly surprised at how much better a 40% improvement can look.” Which Treatment Is Best? That is largely dependent on the needs of the patient and the type of skin that he or she has. Some patients may elect to avoid the higher cost of the fractional laser and be satisfied with the results that the non-ablative laser treatments produce. Other patients may not be willing or able to accept the downtime that comes with laser resurfacing. “With acne scar treatment, we find that you basically get what you pay for,” says Dr. Dover. “In other words, the more downtime and discomfort the patient is willing to endure, the better the results.” Dr. Geronemus is very enthusiastic about the newer acne scar treatment techniques. “The beauty of the new treatments is that we can treat all skin types and all scar types with virtually no risk to the patient, no downtime. Best of all, the patient response to the treatments and the results are almost always positive.”
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Exploring theMost Effective Treatments for Acne Scars
T here is little question that severe acne scarring can be a debilitating condition for sufferers. Even mild acne scarring can drastically alter a patient’s self-esteem and confidence. Fortunately for these patients, there are a number of very effective treatment options that can produce dramatic improvements in the appearance of the various types of acne scars. In general, you can achieve a 40% to 50% improvement in a scar’s appearance, which most patients gauge as a huge success. Treatment Options Exciting new technologies, including the fractional laser, can now be used on patients of all skin type to produce significant improvements with minimal risk and virtually no downtime for the patient. “What I think is important for doctors to realize is that the old conventional wisdom that you cannot treat people of color for conditions like acne scars no longer holds true,” says Roy Geronemus, M.D., Director of the Laser & Skin Surgery Center of New York. “The newer techniques, especially the fractional laser, can dramatically improve the look of all acne scars in patients of any skin type with little risk to the patient.” According to Jeffrey Dover, M.D., Director of SkinCare Physicians of Chestnut Hill and Associate Clinical Professor of Dermatology, Section of Dermatologic Surgery and Oncology, Yale University School of Medicine, and Adjunct Professor of Medicine (Dermatology) at Dartmouth Medical School, there are three primary light-based technologies that are highly effective in treating acne scars: 1. laser resurfacing 2. fractional laser resurfacing 3. non-ablative skin rejuvenation using a near infrared laser. All of the techniques work well with varying levels of side effects, downtime and cost. “My acne scar patients are my favorite patients because they are all so very happy with the improvements that we can make,” says Dr. Dover. “For me, it is very rewarding to have someone tell me that what I did for them changed their lives.” Laser resurfacing uses a CO2 laser to vaporize the upper layers of the skin. The ultrapulsed carbon dioxide laser, erbium YAG laser and the pulsed dye yellow light laser are most frequently used in laser resurfacing. The technique is highly effective in improving the appearance of the skin. However, it cannot be used with all skin types and the patient has to endure significant discomfort, side effects and down time. “Without question, laser resurfacing gives the best results. However it is the most involved and as a result, lots of patients who are good candidates don’t do it,” says Dr. Dover. “But, when patients come in and say they want the best possible improvements and can deal with the downtime that is our choice.” The fractional laser Fraxel SR system from Reliant Technologies uses a 1550 nm diode pumped erbium fiber laser delivered through an optically tracked microprocessor controlled handpiece to produce an array of tiny thermal zones, each about 100 microns in diameter and 400 to 700 microns deep. This produces epidermal necrosis and collagen denaturation, which is very well tolerated as long as the spacing of the zones is more than twice the diameter of the zone itself, or about 200 microns. The stratum corneum is generally not damaged because its low water content reduces absorption of laser energy. The epidermis heals within 24 hours after keratinocytes migrate into the defect. Fractional laser resurfacing offers the benefits of speedy healing and virtually no downtime. Side effects are minimal, typically limited to swelling and redness with no oozing or crusting. Mild swelling should subside within a day or so, and the redness usually fades over several days. Patients can apply make-up immediately after treatment and return to routine activities. There is limited, if any, risk of infection or scarring. “Fractional laser resurfacing is a nice addition to the toolkit. It gives very good results without the serious down time of laser resurfacing. You need to apply some type of topical anesthesia prior to starting the procedure and forced-air cooling during treatment,” says Dr. Geronemus. “We typically do five treatments, though you can continue to see improvements with additional treatments. We generally do two treatments a month, but in some cases if we’re doing aggressive treatment, we might do one a week. After the treatment, we typically see nothing more than a little swelling or redness.” Dr. Geronemus explains that each treatment session with the fractional laser takes about 10 to 15 minutes. Dr Geronemus estimates that he treats about 90% of his acne scar patients with the Fraxel laser. Often, he combines fractional treatment with other non-ablative treatments to improve results in certain patients. His other patients are treated with other techniques for a variety of reasons, including that some patients do not want to pay for the additional cost of the fractional laser treatment, which may be up to 50% more than other non-ablative techniques. In other cases, some patients are reluctant to use a new technology and would rather be treated with a technology that has a longer track record. Non-ablative laser skin rejuvenation, using near infrared lasers such as the CoolTouch (1320 nm), SmoothBeam (1450 nm) and Aramis (1540 nm), also offer effective treatment. “We use all three and have had good results with all of them,” explains Dr. Dover. “The real advantage is the limited downtime, primarily redness for a few days,” he adds. “With the SmoothBeam and CoolTouch, we use topical anesthesia, topical 5% lidocaine cream (ELA-Max) for an hour before treatment,” explains Dr. Dover. “The Aramis is less painful so we can avoid the anesthesia, but it takes longer to do since the spot is smaller. However, the total time for treatment is often less since we’re not waiting for the topical anesthesia to take effect. It can also be cheaper to use the Aramis since the ELA-max is quite expensive.” Preparing Patients for What to Expect Since none of the treatments will completely eliminate the acne scarring, it’s very important that the physician explain to the patient what to expect. This setting of expectation levels will have a real impact on how the patient perceives the relative success of the procedure. “I have had a few patients walk out after I explained that I could not eliminate their scarring completely,” says Dr. Geronemus. “On the other hand, many of my patients are pleasantly surprised at how much better a 40% improvement can look.” Which Treatment Is Best? That is largely dependent on the needs of the patient and the type of skin that he or she has. Some patients may elect to avoid the higher cost of the fractional laser and be satisfied with the results that the non-ablative laser treatments produce. Other patients may not be willing or able to accept the downtime that comes with laser resurfacing. “With acne scar treatment, we find that you basically get what you pay for,” says Dr. Dover. “In other words, the more downtime and discomfort the patient is willing to endure, the better the results.” Dr. Geronemus is very enthusiastic about the newer acne scar treatment techniques. “The beauty of the new treatments is that we can treat all skin types and all scar types with virtually no risk to the patient, no downtime. Best of all, the patient response to the treatments and the results are almost always positive.”
T here is little question that severe acne scarring can be a debilitating condition for sufferers. Even mild acne scarring can drastically alter a patient’s self-esteem and confidence. Fortunately for these patients, there are a number of very effective treatment options that can produce dramatic improvements in the appearance of the various types of acne scars. In general, you can achieve a 40% to 50% improvement in a scar’s appearance, which most patients gauge as a huge success. Treatment Options Exciting new technologies, including the fractional laser, can now be used on patients of all skin type to produce significant improvements with minimal risk and virtually no downtime for the patient. “What I think is important for doctors to realize is that the old conventional wisdom that you cannot treat people of color for conditions like acne scars no longer holds true,” says Roy Geronemus, M.D., Director of the Laser & Skin Surgery Center of New York. “The newer techniques, especially the fractional laser, can dramatically improve the look of all acne scars in patients of any skin type with little risk to the patient.” According to Jeffrey Dover, M.D., Director of SkinCare Physicians of Chestnut Hill and Associate Clinical Professor of Dermatology, Section of Dermatologic Surgery and Oncology, Yale University School of Medicine, and Adjunct Professor of Medicine (Dermatology) at Dartmouth Medical School, there are three primary light-based technologies that are highly effective in treating acne scars: 1. laser resurfacing 2. fractional laser resurfacing 3. non-ablative skin rejuvenation using a near infrared laser. All of the techniques work well with varying levels of side effects, downtime and cost. “My acne scar patients are my favorite patients because they are all so very happy with the improvements that we can make,” says Dr. Dover. “For me, it is very rewarding to have someone tell me that what I did for them changed their lives.” Laser resurfacing uses a CO2 laser to vaporize the upper layers of the skin. The ultrapulsed carbon dioxide laser, erbium YAG laser and the pulsed dye yellow light laser are most frequently used in laser resurfacing. The technique is highly effective in improving the appearance of the skin. However, it cannot be used with all skin types and the patient has to endure significant discomfort, side effects and down time. “Without question, laser resurfacing gives the best results. However it is the most involved and as a result, lots of patients who are good candidates don’t do it,” says Dr. Dover. “But, when patients come in and say they want the best possible improvements and can deal with the downtime that is our choice.” The fractional laser Fraxel SR system from Reliant Technologies uses a 1550 nm diode pumped erbium fiber laser delivered through an optically tracked microprocessor controlled handpiece to produce an array of tiny thermal zones, each about 100 microns in diameter and 400 to 700 microns deep. This produces epidermal necrosis and collagen denaturation, which is very well tolerated as long as the spacing of the zones is more than twice the diameter of the zone itself, or about 200 microns. The stratum corneum is generally not damaged because its low water content reduces absorption of laser energy. The epidermis heals within 24 hours after keratinocytes migrate into the defect. Fractional laser resurfacing offers the benefits of speedy healing and virtually no downtime. Side effects are minimal, typically limited to swelling and redness with no oozing or crusting. Mild swelling should subside within a day or so, and the redness usually fades over several days. Patients can apply make-up immediately after treatment and return to routine activities. There is limited, if any, risk of infection or scarring. “Fractional laser resurfacing is a nice addition to the toolkit. It gives very good results without the serious down time of laser resurfacing. You need to apply some type of topical anesthesia prior to starting the procedure and forced-air cooling during treatment,” says Dr. Geronemus. “We typically do five treatments, though you can continue to see improvements with additional treatments. We generally do two treatments a month, but in some cases if we’re doing aggressive treatment, we might do one a week. After the treatment, we typically see nothing more than a little swelling or redness.” Dr. Geronemus explains that each treatment session with the fractional laser takes about 10 to 15 minutes. Dr Geronemus estimates that he treats about 90% of his acne scar patients with the Fraxel laser. Often, he combines fractional treatment with other non-ablative treatments to improve results in certain patients. His other patients are treated with other techniques for a variety of reasons, including that some patients do not want to pay for the additional cost of the fractional laser treatment, which may be up to 50% more than other non-ablative techniques. In other cases, some patients are reluctant to use a new technology and would rather be treated with a technology that has a longer track record. Non-ablative laser skin rejuvenation, using near infrared lasers such as the CoolTouch (1320 nm), SmoothBeam (1450 nm) and Aramis (1540 nm), also offer effective treatment. “We use all three and have had good results with all of them,” explains Dr. Dover. “The real advantage is the limited downtime, primarily redness for a few days,” he adds. “With the SmoothBeam and CoolTouch, we use topical anesthesia, topical 5% lidocaine cream (ELA-Max) for an hour before treatment,” explains Dr. Dover. “The Aramis is less painful so we can avoid the anesthesia, but it takes longer to do since the spot is smaller. However, the total time for treatment is often less since we’re not waiting for the topical anesthesia to take effect. It can also be cheaper to use the Aramis since the ELA-max is quite expensive.” Preparing Patients for What to Expect Since none of the treatments will completely eliminate the acne scarring, it’s very important that the physician explain to the patient what to expect. This setting of expectation levels will have a real impact on how the patient perceives the relative success of the procedure. “I have had a few patients walk out after I explained that I could not eliminate their scarring completely,” says Dr. Geronemus. “On the other hand, many of my patients are pleasantly surprised at how much better a 40% improvement can look.” Which Treatment Is Best? That is largely dependent on the needs of the patient and the type of skin that he or she has. Some patients may elect to avoid the higher cost of the fractional laser and be satisfied with the results that the non-ablative laser treatments produce. Other patients may not be willing or able to accept the downtime that comes with laser resurfacing. “With acne scar treatment, we find that you basically get what you pay for,” says Dr. Dover. “In other words, the more downtime and discomfort the patient is willing to endure, the better the results.” Dr. Geronemus is very enthusiastic about the newer acne scar treatment techniques. “The beauty of the new treatments is that we can treat all skin types and all scar types with virtually no risk to the patient, no downtime. Best of all, the patient response to the treatments and the results are almost always positive.”
