Improving the look of a scar by creating another wound may seem counterintuitive, but according to a review of 26 studies, treating acne scars with ablative lasers are more effective than treating them with non-ablative lasers.
Patients who underwent ablative laser treatments (meaning that the surface of the skin was strategically wounded) saw as much as an 83 percent improvement, said the researchers from King’s College Hospital NHS Foundation Trust in London who reviewed multiple studies. Those who had non-ablative laser treatments saw, at best, a 50 percent improvement in the appearance of their acne scars.
“Ablative lasers are far more effective than non-ablative lasers when treating acne scars,” Fort Lauderdale, FL, cosmetic dermatologist Dr. Shino Bay Aguilera said when asked about the study findings. “The injury from an ablative laser is greater-therefore there is better collagen remodeling and new collagen formation.”
When the skin is injured, the body goes into overdrive to heal the wound by quickly producing collagen. “This collagen is different than the rest of the normal skin,” Dr. Aguilera explains. “It tends to be thicker and harder.”
With acneic skin, inflammation causes the skin to break and start this quick wound-healing, which eventually leads to acne scars.
“The way an ablative laser works is by destroying the unwanted collagen on the scar that was made in a hurry,” Dr. Aguilera says. “With the laser, the body will, in a controlled manner, make a collagen that is not made in a hurry and that looks a lot more like the collagen in the normal skin surrounding the scars. Therefore, the scars blend better with normal skin, causing them to be less visible.”
One of the drawbacks to ablative lasers, however, was the high rate (as many as 90 percent) of hyperpigmentation following ablative laser treatment. So we asked Dr. Aguilera about other effective treatments for acne scars.
“Non-ablative treatments like Fraxel and Affirm Multiplex will also help blend acne scars, but they tend to require a lot more treatments and the blending takes longer. Yet they tend to be safer for darker skin types [that are more likely to experience hyperpigmentation],” he says.
“Sculptra Aesthetic injected on the acne scar after subcision [surgically freeing the scarred skin from the deeper layers of the skin so that the scar is not anchored down] has also shown to be an effective way to treat acne scars,” he explains. “Using a tiny drop of 50 percent trichloroacetic acid (TCA) into ice-pick scars has shown promising results that no laser or other technology seems to improve.”
Of course, stopping the scars in the first place would be best, but many of us are genetically predisposed to develop them. “The best way to avoid acne scars is to try to control the acne breakouts as soon as they appear,” Dr. Aguilera says. “If you’re using something over-the-counter and there is no resolution after three to four weeks, see a dermatologist right away for evaluation and treatment. And avoid picking at all costs.”
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