Acne scars have historically been problematic for both patients and the doctors who wish to help them. We are proud to say that patients who seek Dr. Rapaport’s guidance at the Cosmetic Skin and Surgery Center have access to the most effective methods currently available to treat scars.
Since acne scars come in various sizes and shapes, individualizing treatments becomes necessary to maximize the results. At the consultation, Dr. Rapaport chooses one or a number of different methods that are customized to patient’s needs. For example, subcision (undermining), the TCA CROS Method, Fraxel resurfacing, CO2 or Erbium Laser Resurfacing, and the use of filler substances are appropriate for different types of lesions.
For smooth-walled (rolling) depressed scars, Dr. Rapaport usually treats the scars with subcision and suction. During a subcision session, Dr. Rapaport uses a specialized needle to break up scar tissue underneath the depression. The ensuing wound repair process results in the production of collagen in the treated area, causing the depression to slowly fill in from underneath. Suction is recommended within a few days of subcision to bring about a more dramatic collagen production response.
For “box car” depressions and certain types of sharper edged scars, subcision in combination with the Fraxel laser has been highly effective. The Fraxel has proven to be an excellent tool to smooth out sharper borders non-ablatively with results that are superior to those resulting from more invasive resurfacing technologies (i.e. CO2). In fact, if the scars being treated are superficial, subcision can probably be circumvented altogether. Additionally, patients being treated with the Fraxel benefit from the laser’s inherent ability to reduce the visibility of pores, a common problem for people plagued with acne.
For certain kinds of pitted scars, Dr. Rapaport will often recommend the TCA localized Peeling (also called the TCA CROSS Method). During such treatment, a high concentration of Trichlorocetic acid is introduced just inside the scar. The resurfacing response that occurs inside the depression stimulates collagen production that, over multiple sessions, causes the scar to rise up and close in on itself.
Excision is recommended to treat pitted scars that are not amenable to the CROS Method. As a general rule, for those patients requiring multiple excisions, at least a localized laser resurfacing is done afterwards to smooth over the remaining stitch marks.
Many types of elevated scars can also be treated by flattening or leveling with laser resurfacing or Radio Frequency surgery.
Full face chemical peels are often recommended for discoloration caused by acne. However, such treatments are not effective on depressed scar tissue.