Global Health Asia-Pacific Issue 2 | 2023 - Page 88


Acne Scarring Is Not Just Skin Depth

Image ( 1 ) is the result attained after two sessions over a period of eight months .

Acne scarring is often the result of delayed and or inadequate medical treatment but it is undeniable that it may even develop despite appropriate intensive therapy . Collagen and other tissue damage , secondary to inflammation of acne , leads to permanent skin texture changes and fibrosis . Acne scarring is a therapeutic challenge to clinicians as many treatments may be only partially effective , leading to patient disappointment and frustration . The detrimental effects of acne scarring are not only limited to impaired physical appearance . Rather , acne scarring has also been associated with depression and other mental health disorders , suicidal ideation , emotional debilitation , embarrassment , poor selfesteem and general social impairment .

Acne scar formation is determined by inflammation depth and duration . Multiple acne scar grading classification systems of varying complexities have been introduced . The most basic , practical system divides atrophic acne scars into three main types namely ice pick , rolling and boxcar scars . It is common for patients to have more than one type of scar .
A plethora of treatment options have resulted from the need to treat various acne scar types , variability of responses noted in various skin types and increasing popularity of minimally invasive modalities .
Preventing and treating acne scars has always been my passion as I truly believe that the scar is not just skin depth . Early accurate clinical diagnosis and targeted interventions are of the utmost importance in preventing acne scars from setting in . The awareness of seeking early treatment for acne is still lacking in the general population in spite of well-researched and documented clinical practice guidelines for acne management . In my clinical practice , I am very particular in choosing the appropriate treatment protocol to curb acne at the earliest stage . With the advent of a vast armamentarium of clinical approaches for acne scars , choosing the right one remains a tough challenge for clinicians . Over time I have tried and tested multiple modalities and I have come to realise that a combination of different approaches always leads to the best outcome .
Different treatment modalities have been used for the revision of atrophic acne scarring , with varying degrees of success . Many controlled trials have demonstrated that moderate to severe atrophic acne scars can be safely improved through ablative fractional CO2 laser resurfacing ( fractional laser skin resurfacing , FLSR ). Although FLSR is still the most popular therapeutic modality for the correction of acne scars , it is not always effective in all types of atrophic lesions , the most common type of defects encountered after inflammatory acne . Over the past decade , non-ablative laser resurfacing and radiofrequency micro-needling have been shown to create some improvement in the appearance of these atrophic scars .
There has also been interest in non-autologous augmentation by way of injections of hyaluronic acid ( HA ), polymethylmethacrylate microspheres ( PMMA ) and calcium hydroxyapatite ( CaHA ) to improve atrophic acne scars .
Multiple clinical and histologic studies have documented the safety and efficacy of CaHA microspheres . By its very composition , CaHA is designed to provide immediate correction and longterm bio stimulatory neocollagenesis . Over time , the gel is absorbed , fibroblasts appear and the process of neocollagenesis begins , stimulating the gradual growth of the patient ’ s own collagen .
In my clinical experience , the synergy of Potenza™ ( CynoSure ) micro-needling radiofrequency technology with the bio-stimulating effect of Radiesse ® ( CaHAbased filler ) has given me excellent results for atrophic acne scars . At least two to three sessions over a period of three to four months will be required for optimal results .
Dr UsHa Hoh is the CEO & Senior Medical Director Of MX Clinic and APAC Trainer & International Speaker For Merz Aesthetics .
86 ISSUE 2 | 2023 GlobalHealthAsiaPacific . com