Acne Scarring Treatment: Non-Energy Based Techniques

Acne scarring is one of the most common negative side effects of acne caused by the uneven formation and deposition of collagen around the inflamed follicles. The scarring leads to a negative impact on the quality of life, including depression, anxiety, low self-esteem, and even poor academic performance. Over recent time periods, medical interventions have evolved to successfully decrease the visibility of scars. The types of medical treatment for acne scarring have been grouped into two broad categories: energy-based and non-energy-based techniques.

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.

Non-energy-based techniques are discussed in further detail below.

Subcision

Subcision is defined as a minimally invasive surgical technique that involves targeting the scarring tissue that pulls the skin down and creates a trophic scar (an indented scar). The procedure consists of dissecting and releasing these scarring tissues, resulting in a less prominent indentation. The entire procedure is performed under local anaesthesia and is not painful.

Excision

Very deep scars can be excised and closed with stitches. Excision 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 as far as the papillary and/or reticular dermis layer, enabling the remodelling of the skin's structural proteins. The procedure is performed under local or general anaesthesia using a motorised handpiece that rotates a diamond fraise or wire brush. Pinpoint bleeding may occur on the raw wounded areas, and appropriate wound care is advised by the dermatologist.

MDA differs from DA in that it is considered a more superficial treatment, removing only the stratum corneum layer and inducing 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, MDA is a less effective method than DA and therefore requires multiple treatments to achieve the best results.

Micro-Needling

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

Chemical Resurfacing

Chemical resurfacing treatment involves the application of chemicals, such as trichloroacetic acid, to the skin in order to stimulate the destruction of the outer damaged layer. This process accelerates natural exfoliation, 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 level, and deep. The very superficial level is a purely cosmetic procedure performed in a cosmetic spa and does not have a significant impact on scarring.