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Acne Scar Reduction & Treatment
what are they? what causes them? and what can i do to treat them?
Acne Scar Reduction And Treatments

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{ Acne Scar Reduction And Treatments }

What are acne scars and what causes them?

People with acne scars suffer from a relatively common condition, specifically depressed, hollowed out indentations of the skin following inflammatory acneiform (pimple) eruptions. Deep cystic acne and aggravated outbreaks of pimples, either in adolescence or in adulthood, can result in significant damage to the many structures of the skin, including loss of collagen elastin and support substances. This loss of important structure to the skin can result in localized depressions, indentations and “craters” called acne scars. Acne scars can be very small, narrow indentations and pits called “ice pick scars” or they can be broader based, wider and more distensible depressions, called “rolling hill” acne scars. There can be a hereditary predisposition to acne and the treatment of acne, as well as the acne scars, should be addressed.

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What are acne scar treatments?

Acne scar treatments involve the application of fractional laser and fractional radiofrequency resurfacing technologies as well as radiofrequency skin tightening devices and intense pulsed light and pulsed dye lasers to optimize the improvement in the appearance of acne scars.  At SpaMedica, Dr. Mulholland has assembled the world’s best combination of acne scar treatments to ensure the Toronto Acne Scar patients get the best possible outcome with the smoothest, clearest, brightest possible skin. Acne scars come in a variety of shapes and sizes, from mild to moderate acne scars. They can also be deep, rolling hill to icepick-type acne scars.  At SpaMedica, Dr. Mulholland has been in the forefront of pioneering and developing many of the currently used technologies to improve the appearance of acne scars and the ability to get acne scar improvement has never been better, especially with Dr. Mulholland’s and SpaMedica’s multiple-applicator approach to their treatment.

How do acne scar treatments work?

Acne scar patients can be treated at the SpaMedica Toronto Cosmetic Plastic Surgery Centre by Dr. Stephen Mulholland and his team of experienced cosmetic dermatologists, using a variety of techniques and procedures. One of the more common treatments for acne scars includes a combination of fractional carbon dioxide laser, or fractional erbium ablative lasers for fractional laser resurfacing of the skin. The fractional ablative lasers and infrared “fraxel” type lasers send columns of micro laser beams into the skin causing a thermal injury to portion of the skin overlying the acne scar. The thermal stimulus from the column of laser light stimulates reformation of new collagen and elastin, plumping up the acne scar and diminishing its appearance.

Acne scars can also be treated from underneath to plump up their appearance with injectable soft tissue dermal fillers. These can be combined in conjunction with fractional lasers treating from both underneath and through the surface of the acne scars. Injectable soft tissue dermal fillers include products such as Restylane, Perlane, Juvederm, Teosyal, Sculptra and Radiesse. Dermal fillers can plump up the depressed acne scars to diminish the indented, depressed appearance and smoothing of the skin surface.

Other treatments used to treat acne scars include intense pulse light photofacials, and photofacial RF treatments, which will decrease any redness and pigmentation associated with acne scars. In addition, acne scars can benefit from skin tightening procedures such as radio frequency and infrared devices like Thermage, eMatrix Fractional Resurfacing, ReFirme Infrared Laser Tightening. Mini lifts of the cheek and face can also smoothen the skin of acne scars and can be used in conjunction with any of the aforementioned laser and heating device technologies. Dr. Mulholland can also improve the appearance of acne scars by doing fat grafting in the cheeks and other areas to support the structure of the overlying acne scarred skin. In many cases, Dr. Mulholland will combine all or many of the aforementioned laser and surgical skin beauty and acne treatment procedures to get the optimal result. Most of the procedures can be performed under local anesthesia and as an outpatient.

How is my acne treatment procedure performed?

Generally, acne scars require a series of treatments, between three and six, performed once every three weeks.  The acne scar treatment involves the application of intense pulsed light, photo facial and pulsed dye and Long Pulsed YAG laser energy to remove any redness or brown pigmentation at the base surrounding the acne scars (Figure 1.)

Acne scars are treated through a  series of treatments

Figure 1.  Toronto Acne Scar patients receive multiple technologies at SpaMedica. The first applicator is A. IPL (intense pulsed light) or Pulsed Dye, YAG or pigment lasers which when pulse on the skin. B. and C. can clear the red or brown pigmentation which is common at the base of acne scars.

On the same visit, after the IPL (intense pulsed light) colour correction laser acne scars treatment is then followed by a non-ablative RF heating device to tighten the skin, which stretches the acne scars, also improving their appearance.  Much like pulling on your cheek improves the appearance of “rolling hill” acne scars, so will skin tightening created by non-ablative radiofrequency heating devices (or even a facelift, which Dr. Mulholland offers his older cheek acne scar patients).  The Non-ablative Radiofrequency (RF) skin tightening devices works by painlessly heating the skin up to a tolerable 42-43 degrees Celsius. It maintains this for 20 minutes.  By heating this skin at this temperature for this length of time over 6 treatments and 6 weeks, the skin responds with the production of new collagen. There is up to 20-25% more collagen which tightens the skin and smooths the acne scars.  There are many Non-ablative RF heating devices that Dr. Mulholland and his SpaMedica medical aestheticians and nurses can apply to your acne scars including: Thermage, AccentVenus Freeze, FORMA, Exilis, Tri Pollar, ReFirme and Sublime. Dr. Mulholland and his technicians will select the best non-ablative RF heating device for your skin. The FORMA is one of the more effective RF skin tightening devices, as this device will heat the skin (and its undercarpet, called the dermis) and will monitor the temperature and automatically turn off the RF energy when the therapeutic end point is met. It turns the RF and heating back on again when the skin temperatures falls 0.1 degree Celsius below the end point of 42-43 degrees C.   This automated on-off control, also called ACE control (Acquire, Control and Extend) makes the treatment very comfortable, by eliminating temperature spikes as it sustains the therapeutic skin tightening temperature as long as needed. It is also safe as it avoids temperature spikes, which can cause pain and burns. (Figure 2)

FORMA is one of the RF devices used in acne scar reduction treatments.

Figure 2.  After IPL and laser colour correction, Toronto Acne Scar patients will then undergo skin tightening with a non ablative Radiofrequency (RF) skin tightening applicator, such as the FORMA, Venus FreezeAccentExilis, Pelleve, ReFirme or Sublime. Using ACE control, the skin temperature over the acne scars and face is sustained at 42-43 degrees Celsius for 10 minutes in each area. This is performed once weekly for 3-6 sessions and results in 15-25% more collagen, tighter skin and smooth acne scars.

The final treatment applicator each visit is a fractional laser and/or fractional radiofrequency devices, such as the Fractora, the INTRAcel™, or eMatrix Fractional radiofrequecy technologies and the Fraxel® type fractional CO2 and/or LUX 1540 infrared fractionals, all combined and alternated to give the best possible textural improvement in your acne scar deformity. The fractional ablative devices use RF (electrical) or laser energy to burn tiny holes into the acne scarred skin. These microscopic thermal craters stimulate new collagen, elastin and ground substances which resurface the acne scar and fill up the deflated and scared depression caused by the inflammatory acne process.  Dr. Mulholland has been a pioneer in the development of fractional resurfacing and is one of the developers of the renowned Fractora, ematrix, Intracel, Matrix IR and SmartSkin fractional CO2 (Figure 3).

The Fractora helps improve the acne scar's texture

Figure 3.  Fractional RF, like the above illustration of the Fractora and Fractional lasers use electrical needles (RF) or laser energy to burn microscopic craters into the depressed acne scar. The spaces that are left in between the craters act as “reservoirs” to produce new collagen and ground substances to fill in the thermal crater and build up the depressed acnes scars. It makes them appear much smoother or it can even eliminate them.

It is important that you have control of your acne outbreaks and a non-surgical acne control program may be instituted prior to the treatment of your acne scars. You don’t want to be having active acne at the time of treatment or it can stimulate a worsening of the active acne.  During your consultation, if active acne is still an ongoing issue for Toronto Acne Scar patients, an active acne treatment program will be instituted, using blue light, photodynamic therapy SonoPeels and intense pulsed light photo facials, with or without topical or oral antibiotics and low-dose Accutane.  Patients who are on low-dose Accutane do not have to stop taking this oral Vitamin A, as they can still undergo their non-surgical acne scar treatment program.

The final applicator that is used to optimize the improvement in Toronto Acne scar patients involves a high-tech device called the Enerjet. The Energet is a needle and laser-free device that uses high pressure injection fluid mixed with injectables like Restylane and Juvederm, to propel the product into the scar itself through hundreds of tiny microchannels.  The pressure (called Baro-dissection) and fluid (called hydro-dissection) then spread out within the acne scar skin, creating hundreds of horizontal channels filled with Restylane or Juvederm. The scar gets plumped up and smoother and over time, the Restylane or Juvederm filler gets replaced with the patient’s own collagen. The Enerjet is fast and relatively painless and offers a deeper acne scar improvement than lasers can provide. (Figure 4).

EnerJet helps to inject fluid particles like Juvederm and Restylane through the surface of acne scarred skin.

Figure 4.  The Enerjet uses a gentle, but powerful needle-free kinetic injection process, where high pressure fluid particles such as dissolved JuvedermResytlane or Bolletaro, are pushed through the surface of the acne scarred skin and then they disperse laterally. The fluid Jet disperses into the dermis laterally covering 1,000 times the entry point (about 1-2 cm radius). The Jet propulsion leaves the skin intact, but creates baro-dissection and hydro-dissection that adds volume to the depressed acne-scarred skin to elevate and smoothen it.  Over time the volume effect of the filler is replaced by the patient’s own structural collagen.

Combination therapy works on acne scar colour, texture and skin tightening. SpaMedica and Dr. Mulholland offer Toronto Acne Scar patients the best possible outcome in resolution of the acne scars that technology can deliver.

Why does Dr. Mulholland and SpaMedica use combinations of Fractional Devices, like lasers and Radiofrequency devices to treat Acne Scars?

It is critical for Toronto Acne scar patients to understand the nature of the underlying injury that acne inflammation and scarring leave. In general, most acne scars are very, very deep, if not going through the entire thickness of the skin.  If these scars are treated only with laser energy, to go as deep as the acne scar itself, a tremendous amount of superficial thermal energy must be delivered and the thermal craters will be very wide at the surface to get down deeply. This degree of excessive thermal injury can result in lightening of the skin (hypopigmentation) or scarring.  By using Fractional CO2 and Erbium lasers in the superficial and mid-level acne skin levels, Dr. Mulholland and SpaMedica can avoid these excessive thermal risks. To correct the depths of the acne scar depressions, Dr. Mulholland has pioneered the use of silicon coated Fractional Radiofrequency Needles. The first 2000 microns is silicone coated, while the last 1000 microns are not coated. They deliver a deep fractional ablation and create deep collagen, while not in jurying the superficial skin (the skin is only 2500-3000 microns deep in most facial acne scar areas). These silicone RF fractional needles are found on the Fractora and the Intracel devices, both pioneered by Dr. Mulholland (Figure 5 and 6). The RF fractional silicon coated devices allow thermal fractional injury to go very deep, but spare the epidermis and superficial skin, while uncoated RF fractional needles, or the fractional lasers are used to treat the superficial and mid-levels of acne scarred skin. Finally, after the Fractional laser and RF devices, the deep layers of the acne scars are treated with the Enerjet, needless kinetic propulsion.

A.

Fractional RF device

B.

Figure 5.  A. The Fractora 3000 micron applicator has fractional silicon coated needles that leave only the last 1000 microns uncoated. Thus, the skin is not thermally treated only the depths of the acne scar are. B. This skin sparing fractional RF device, delivers a BI-FRACTIONAL, or BiFRAX injury, fractional horizontally and vertically. By sparing any thermal injury on the surface of the skin, the Fractora coated tip allows the deep ablation of acne scarred skin without excessive risk of superficial skin scarring or hypo-pigmentation.

Who is a candidate for acne scar treatment?

Good candidates for acne scar treatments are Toronto acne scar patients who have suffered from acne that resulted in deforming acne scars.  The acne scars may be pigmented or non-pigmented, red, brown, white, deep, superficial, icepick or rolling hill. All scars will benefit from noticeable improvement in the appearance with a combined applicator technology SpaMedica program. The best candidates are those that don’t have ongoing medical illness or skin diseases and have control of their acute, inflammatory, eruptive, nodulocystic or papular acne.  SpaMedica employs some of Toronto’s best cosmetic dermatologists and medical aestheticians to ensure that your active acne is under control prior to treatment of your acne scars.  Good acne scar treatment candidates have a realistic expectation about the kind of improvements and results that can be achieved, which is 30% to 70% reduction in the appearance of acne scars. After the treatment, there’s a combination SpaMedica acne scar treatment program available.

What kind of anaesthetic is used during my acne scar treatment?

Toronto acne scar patients who present to SpaMedica for the combined applicator acne scar treatment program have these treatments performed under topical anaesthesia and an air chiller device.  Generally, the treatments are quite well-tolerated and this combined air chilling and topical anaesthetic cream makes the treatments acceptable, if not comfortable. Occasionally, for fractional CO2 resurfacing, local anesthetic will be injected.

Is the acne scar treatment painful?

The use of the topical anaesthetic cream and air chiller make the treatment of your acne scars reasonably comfortable.  Any time there is laser energy or fractional resurfacing energy used, there will be a degree of discomfort, but generally this discomfort is acceptable and most patients tolerate the procedure well.

How long does the acne scar treatment procedure take?

Each visit to SpaMedica will be a multiple applicator session.  The colour correction lasers and intense pulsed light, the non-ablative radiofrequency skin tightening as well as the fractional laser and infrared devices and Enerjet take approximately one hour and 15 minutes to complete treatment, depending on the size and location of your acne scars.  Acne scars can be treated OFF the face, in body areas.  Toronto acne scar patients commonly present to SpaMedica and Dr. Mulholland to have the multiple acne scar applicator program on the upper back for an improvement in the appearance of body acne scars as well as face and, rarely, on the chest, particularly in males.

The multiple applicator treatment is performed once every 3-6 weeks for three to six sessions, depending on the severity of the acne.

How long is the recovery following my acne scar treatment?

There is a modest amount of recovery following the acne scar treatment.  The area of treatment is red and somewhat swollen and generally subsides, depending upon the energies used by 2-5 days. If you are prone to bruising, the Enerjet can leave some bruising and swelling for 4-7 days. The fractional RF and laser devices leave skin dry and crusty for 4-7 days, while the IPL and non-ablative RF have essentially no downtime.  Most patients, with moderate acne scars can go back to regular activities 2-3 days following each treatment, while those Toronto acne scar patients with severe acne may need 5-7 days off.

How will I look after my acne scar treatment?

There will be a mild to moderate degree of redness, swelling, edema in the tissues.  There may be some discolouration and this will be increased if hyperpigmentation or redness has been treated.  This will take usually between 24 hours and one week to subside and resolve. Patients with severe acne scarring will have several days of strong edema, swelling, bruising and crusting.

What kind of results can I expect following my acne scar treatment?

Toronto acne scar patients who present to SpaMedica will get the best possible combination technologies and procedures applied to their acne scars.  With this non-surgical approach to acne scar improvement, patients can expect between 30% and 70% reduction in the appearance of their acne scars.

This Toronto patient underwent acne scar reduction treatments

Figure 6.   Toronto Acne Scar patient with acne scar improvements following a SpaMedica multiple applicator program.

What are patients saying about their acne scar treatment?

Toronto acne scar patients are very happy with the results of their SpaMedica multiple applicator acne scar program, as acne scars can be quite disfiguring and acne scar patients can be quite self-conscious.  To be able to achieve 30% to 70% reduction results in a very pleasing result for patients who suffer from acne scars.  Dr. Mulholland has performed these acne scar treatments and procedures on television on multiple TV shows. The patients’ impressions of their improvement can be observed by watching the video on this content page.

This patient underwent a Fractora scar reduction treatment.

Figure 7.  Multiple applicator and Fractora Acne scar improvement.

How long will the results of my acne scar treatments last?

Toronto acne scar patients who have undergone the multiple applicator SpaMedica acne scar treatment program can expect the results to be very long-lasting.  However, the collagen and elastin that has been built up under the acne scars will continue to be broken down by normal aging processes.  Over time, the skin gets aged, thinner and more lax. The laxity pulls on the acne scars and makes them look larger and worse.  It is important to maintain the collagen content and improvement achieved in your program, so Dr. Mulholland will recommend a multiple applicator, single maintenance treatment session every three to four months to maintain the 20% to 25% more collagen and elastin that has been created and the tautness and tightness that has improved the appearance of your acne scars.

Is there any maintenance required following my acne scar treatment?

Yes, to protect your acne scar improvement, there is maintenance.  The maintenance required is a single, multiple applicator treatment every three to four months.  This simple maintenance program will ensure that you continue to protect the 20% to 25% more collagen, elastin and ground substances that were achieved and the skin tightening and smoothening affect that the multiple applicator SpaMedica acne scar treatment program provided.

Patients who have their aesthetic concerns addressed with one or more of the minimally invasive, or non invasive procedures for their acne scars, will undergo a natural and normal facial ageing of the acne scar improvements after their procedure. In general, SpaMedica and Dr. Stephen Mulholland will recommend some non-surgical treatments that are designed to be performed intermittently throughout the year, perhaps once every three to four months, in order to protect the improvement in the acne scar appearance and the youthful rejuvenation that has been achieved through cosmetic surgery or the minimally invasive acne treatments. These maintenance treatments may include Botox Injectable, soft tissue fillers, fractional infrared, fractional laser and radiofrequency skin tightening procedures.

SpaMedica has been treating acne scar patients in Toronto since 1997 and it’s Canada’s oldest, most recognized, experienced and reputable cosmetic plastic surgery centres.

Acne scar patients that get a good result with any variety or combination of treatments by Dr. Stephen Mulholland and SpaMedica Toronto will rarely have a reoccurrence of the acne scars unless the underlying acne condition is not treated and controlled. The inflammatory component of the acne must be treated prior to treating the scars and there are a number of acne treatments available. Please refer to the acne section of this website for more details. Many of the acne scars can be treated multiple times, every 8 to 12 weeks by Dr. Mulholland and his team of cosmetic dermatologists.

How much will my acne scar treatment cost?

The cost for your combined applicator, multiple treatment SpaMedica acne scar treatment program can start as low as $1,500.  The price ranges depending on the severity of the acne scarring, the number of treatments required, between three and six, and the number of areas treated.

Why choose Dr. Mulholland and SpaMedica for my acne scar treatment?

By choosing Dr. Mulholland and SpaMedica, Toronto acne scar patients can be assured of receiving the highest grade of treatments and the best possible combination of technologies available in the medical space to treat your acne scars.  Only with multiple applicators and depths of treatments can deep acne scars show optimal improvement. Most centres will offer you one particular treatment; at SpaMedica, you’ll have the best combination of energy-assisted devices that will greatly improve the overall collagen response and smoothness of your acne scars

How do I schedule an acne scar reduction consultation?

Toronto acne scar patients interested in the SpaMedica acne scar treatment program should simply click on the consult e-mail request form located on this page or call 877-712-8367 to speak to a SpaMedica representative who will schedule you for an acne scar consultation.  Call now to achieve smoother, brighter, more compelling skin.

SpaMedica Cosmetic Plastic Surgery Centre and Dr. Stephen Mulholland recommend the following treatments for acne scars patients:

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SpaMedica® YORKVILLE
Cosmetic Surgery and Laser Skin Care Spa:
66 Avenue Road Suite 4
Toronto, Ontario M5R 3N8
Tel: 1-877-712-8367