Acne Scarring Removal: Non-Energy Based Techniques

Treatment options for acne scarring are split into two categories: non-energy based and energy based. Non-energy based options include subcision, excision, dermabrasion, micro-needling, and chemical treatment. Energy based options include fractional radiofrequency, ablative and non-ablative lasers, intense pulsed light, and plasma skin regeneration.

Subcision

Subcision is a minimally invasive surgical technique that involves dissecting and releasing scarring tissue that pulls the skin downward, creating an atrophic scar (an indented scar). As a result, the indentation is less prominent. The procedure is performed under local anaesthesia and is not painful.

Excision

Very deep scars can be excised and closed with stitches. It is not the first-choice procedure and is reserved for scars that cannot be corrected with other options.

Dermabrasion and Microdermabrasion

Dermabrasion (DA) and microdermabrasion (MDA) are two techniques that resurface the skin on the face by mechanically inducing damage to the skin in order to stimulate re-epithelisation (regrowth). DA involves the complete removal of the epidermis and reaches into the papillary and/or reticular dermis layer, enabling remodelling of the skin's structural proteins. The procedure is performed under local or general anaesthesia using a motorised hand piece that rotates a diamond fraise or wire brush. Pinpoint bleeding may occur on the treated area, and appropriate wound care is advised by the dermatologist.

MDA differs from DA in that it is considered a more superficial treatment, as it only removes the stratum corneum layer and induces the natural process of exfoliation. Various devices can be used to perform this procedure. In comparison with DA, MDA can be repeated after shorter time intervals, does not require anaesthesia, is not a painful process, and has fewer post-procedure complications. However, it is a less effective method than DA and therefore requires multiple sessions to achieve the best results.

Micro-Needling

Skin micro-needling involves puncturing the skin in vertical and then horizontal patterns using a specialised device. It carries a lower risk of post-inflammatory hyperpigmentation and can be performed on all skin types. Due to the discomfort associated with the procedure, topical anaesthetic creams are often recommended beforehand. Micro-needling is also effective for the treatment of other skin conditions, such as burn scars, wrinkles, and pigmentary disorders.

Chemical Treatment

Chemical treatment involves the application of a chemical agent, such as trichloroacetic acid, to the skin in order to stimulate the destruction of the outer damaged layer. It accelerates the natural exfoliation process, leading to remodelling of the skin tissue and a reduction in acne scarring visibility. Chemical treatment is classified by four levels of depth: very superficial, superficial, medium, and deep. Deep peeling requires sedation and is typically performed in a hospital setting. Superficial to medium-depth treatments are performed in a physician's office by a dermatologist or plastic surgeon.