10 In-Office Treatments For Acne And Acne Scars
It’s the stuff of coming-of-age novels and beloved TV series. Oh, and they happen to everyone. We’re talking about BLEMISHES.
“We’ve all had the same horrifying experience during puberty or early adulthood — fretting over the pimple which appeared overnight, applying ointments, creams, and lotions in the hopes of reducing the size and appearance of the spot,” says New York City-based board certified plastic surgeon, Ryan Neinstein, MD. Not just a teenage condition, acne can impact men and women alike well into adulthood. And, if that is not enough, acne can leave behind a pesky parting gift: acne scars.
According to research published in The Journal of Clinical and Aesthetic Dermatology, 80 percent of people between the ages of 11 and 30 years have been affected by acne vulgaris and the vast majority have experienced some degree of acne scarring. The scarring is most common on the face, neck, and back.
While over-the-counter and prescription lotions and potions can do the job, treating active acne lesions and post-breakout scarring sometimes calls for professional attention. Fortunately, there are treatments available in both dermatology and plastic surgery offices that can help heal and improve the appearance of the affected skin. “A multi-modal approach tailored to each patient greatly improves the efficacy of treatment and the patient’s final appearance,” Dr. Neinstein says. Below are some of the best in-office treatments for acne and acne scars.
In-Office Acne Treatments
For the uninitiated, acne vulgaris is an inflammatory process affecting the pilosebaceous units of the face, chest, shoulders, and back. A pilosebaceous unit consists of a hair follicle, sebaceous gland, and a small arrector pili muscle. These units normally produce sebum and keratin. But when production is altered, a pimple or comedone can form. If bacteria like Propionibacterium acnes (a.k.a. P. acnes) get into the affected pore, the area of around the pilosebaceous unit becomes inflamed and red. To treat active acne lesions, an array of resurfacing and therapeutic treatments can be employed.
1. Light Therapy
New York City-based board certified plastic surgeon Jennifer Levine, MD, likes to use a device by Nordlys™ called Ellipse IPL™ to treat current breakouts and prevent future ones. Like other intense pulsed light (IPL) treatments, it uses narrow bands of light to kill bacteria and target the red discoloration of active acne. “This treats active lesions, and also prevents new acne from erupting, which then leads to less scarring,” Dr. Levine says. The procedure is good for Fitzpatrick skin types I through IV, but it is not suitable for darker skin tones, she notes. Three to five treatments are required for best results (which are long lasting), though some maintenance may be required, Dr. Levine says.
Another form of light therapy that can banish breakouts? Blue light. Jessica Weiser, MD, a board certified dermatologist and founder of Weiser Skin in New York City, recommends Celluma blue LED light therapy to reduce P. acnes bacteria on the surface of the skin.
Microdermabrasion can be helpful to encourage skin turnover and decongest pores and small comedones — all of which speeds up the acne healing process while warding off future breakouts, Dr. Weiser says.
At his New York City practice, board certified cosmetic dermatologist Paul Jarrod Frank, MD, recommends the Aerolase laser to treat acne, inflammation, and the marks left behind. Treatments can be scheduled every two weeks and there is no downtime, he says. Additionally, a Laser Genesis facial coupled with cryotherapy can do wonders to calm and soothe the skin. The combination treatment is “good to calm irritated, inflamed acne,” Dr. Frank says, thanks to the duality of the anti-bacterial and anti-redness laser with cold therapy. It takes 10 minutes, has no downtime, and provides results in as soon as 24 hours, he adds.
You may be tempted to take pimple popping into your own hands, but extractions are best left to the professionals. “Medical-grade sterile acne extractions are an important component of a comprehensive acne treatment regimen,” Dr. Weiser says.
In-Office Acne Scar Treatments
Depending on the severity, acne patients may experience scarring and post-inflammatory hyperpigmentation in the aftermath of a breakout. “At times, inflammatory acne lesions can lead to long-lasting or permanent changes in pigmentation and scarring of the affected skin,” Dr. Neinstein says. “Multi-modal or combination treatments work to correct changes in pigmentation as well as scarring.”
Known for its ability to improve skin tone and texture, microneedling has shown promise as a treatment for acne scars. The tiny needles cause small areas of injury, which stimulate collagen production in the area. “This is beneficial since acne scarring is often due to a localized depletion of collagen,” Dr. Neinstein explains.
While microneedling works well alone, it works even better when paired with additional modalities. Both Dr. Neinstein and Dr. Weiser say new devices that couple microneedling with radiofrequency offer an added benefit. As the needles enter the dermis, a pulse of energy is applied to further assist in the remodeling process. Platelet-rich plasma (a.k.a. PRP), meanwhile, can boost results, too. “Recent research has shown a significant improvement to acne-scarred skin when PRP was applied compared to microneedling alone,” Dr. Neinstein says. These therapies have minimal discomfort and very little downtime.
Not just for active acne, Dr. Levine uses the non-ablative Nordlys™ Frax 1550 to resurface the skin. “There are many types of acne scars —ice pick, rolling, caters, etc. — so it requires multiple treatments,” Dr. Levine says. “And you may need to change the settings or passes in different areas.” Like the Ellipse IPL™, it is best for skin types I, II, III, and IV. Multiple sessions are required for best results, and “the treatment lasts as long as there is no new scarring from active acne,” Dr. Levine says.
7. Dermal Filler
A treatment option for depressed acne scars is injectable dermal filler. “These are particularly effective in treating ice pick and boxcar scars,” Dr. Neinstein says. An experienced injector will have knowledge of numerous fillers and their associated characteristics and potential collagen-building properties. “Each filler has a different lifespan within the skin,” he explains. “Numerous fillers have been shown to stimulate collagen production by fibroblasts, which will also improve the appearance and character of the damaged skin.”
8. Facial Fat Grafting
For those who prefer autologous fat to fillers, facial fat grafting is another option. Fat cells (the smaller components of adipose tissue) are injected into the scars to improve volume. “This has shown promise in improving both the depth of scars as well as the skin quality,” Dr. Neinstein says. A sample of fat (often from the abdomen or thigh) is obtained using local anesthesia, the fat is processed, and it is then injected into the treatment areas in a manner similar to that of dermal filler, he explains. “Filtration of the fat to obtain smaller particles, such as stem cells, has been shown to rejuvenate and improve the overall appearance of the affected skin,” Dr. Neinstein explains.
9. Chemical Peels
Available in superficial, medium, and deep concentrations, chemical peels promote skin turnover, enhance healing, and reduce the pigmentation and discoloration caused by acne. They can improve skin tone and texture to restore a healthy, even complexion, Dr. Weiser says.
10. Punch Excision
Violence is never the answer, but Dr. Neinstein says a punch excision is a tried-and-true option for treating ice pick and boxcar scars. This procedure involves a small punch just larger than the scar made in the skin. “The small punch wound is then sutured with a single stitch or left to heal without a suture,” he says.
When OTC and prescription topicals aren’t doing the trick, there are professional procedures that can help heal and prevent active acne and improve the appearance of scars. Consulting with a board certified dermatologist or plastic surgeon will ensure you’re on the best treatment regimen for your skin concerns.