The first step is to see if you have pigmentation issues -not really classed as acne scars, but this is controversial, or if you have contour changes. The best thing to do is to examine under tangential or angled lighting, as this will reveal all. Once this is done, scars can be subtyped and mapped, with high resolution photos. The second aspect, which is equally as important is to examine scars upon animanation, namely when you speak, smile and move your face. This will give me an idea of the amount of tethering and anchored acne scars. Time and time again I get request for ‘what is the treatment’ with static photos, an impossible task to answer correctly. Acne scar assessment has to be done live- with the patient in front of you, and lighting from all angles. Photos do not map scars as well a real time examination under magnification and lighting.
I then select the best method to address our acne scar type. Once again it is the method of acne scar removal that will give the biggest change. Taking note of your skin colour, I devise a plan that may consist of –
Ice pick scars are best treated with chemical peels such as TCA CROSS or punch excision
Rolling scars are best treated with fractional lasers Fraxel, INFINI Microneedling, Dermarollers, skin needling and subscision
Box car scars are best treated with laser resurfacing using a co2 or erbium laser such as Profractional
Atrophic scars are best treated with fillers such as Juvederm, Restylane, Bellafill, or even fat transfer
Most clinics will by default ‘prescribe’ a laser treatment such as Fraxel, fractional laser, or have an answer such as Derma Roller or microneedling. Whilst these treatments can give some results, they do not offer Gold Standard acne scar treatment solutions.
A bespoke or individualised treatment approach is best, because it is your scars that are being treated and not just a device that is being used for ‘acne scarring.’ If you look at my acne scar before and afters you will notice one trend- everyone will have a mixture of scars and very rarely will a person have only one scar type. Most patients will present with a variety of scars, some patients will have more atrophic acne scarring, whilst others will have deep ice pick scars. Some patients will present with acne –pimples- zits and acne scars as well. The combinations are endless.
So the very first step I do is to ask- what types of acne scars do you have? What gives me the most information is angled lighting. This is how you visualise scars, and it is the same method I use to find acne scars, map them out, and then treat them. Most patients notice their acne scars when lighting conditions changes, classic examples are when they are in the bathroom, or in a dimly lit room, or when light shines at a certain angle. It might be at night in the car, or the reflection of glass or a mirror. I use the same principles that patients see their scars to examine, identify and treat acne scarring.
Any specialist who does scar revision to a high level would use angled lighting to determine scar types and if appropriate ask you to animate. Shining direct and bright surgical lighting reveals very little, but by dimming lights and shining light at different angles reveals a whole dimention of acne scarring. In many of my upcoming videos you will see me using newer techniques such as INFINI PRP with PRP mask occlusion, and various subsciion filler combination techniques.