Patients Are Interesting in Trying New Approaches • Herbal medicines and both oral and topical vitamin preparations are popular with many acne patients. • Women often use nutroceuticals and cosmeceuticals — skin care and makeup products that contain a retinol preparation or vitamin C.
DERMABRASION
In dermabrasion,
a wire brush or diamond fraise is used to "abrade" the epidermis and papillary dermis.
Disadvantages of dermabrasion include hypopigmentation, bleeding, and, as compared with laser resurfacing, decreased precision. In addition, aerosolization of blood and of viral tissue particles occurs.
MICRODERMABRASION
This relatively new technique involves the use of aluminum, salt, or diamond microparticles to bombard the skin and a suction apparatus to vacuum away the most superficial layer(s) of the epidermis.
There is minimal to no recovery time, but the results are extremelyappropriate for treating atrophic scars that are relatively few. The technique requires minimal recovery time, but its results are temporary.
Risks include allergic dermatitis, lack of response, and, rarely, overcorrection.
One of the latest trends, hyaluronic acid injections, is perhaps more appropriate for the aging face than for acne scars. This technique is widely used in Europe and Canada, but it awaits approval by the Food and Drug Administration in the United States. Autologous fat transfer is another increasingly popular technique.
The first filling agent was free silicone, injected in microdroplets.
It was very effective, but the Food and Drug Administration banned it.
SUTURE-ASSISTED RESURFACING
A new, innovative technique, suture-assisted resurfacing combines two modalities in one treatment session. It is ideal for patients who had miliary acne, which leaves scarring that consists of numerous tiny pits less than 2 mm in depth. The CO2 laser is used to resurface the entire face or affected area with two passes. Afterward, each military scar is incised with a triple bevel 18-gauge needle. A single 7-0 nylon or polypropylene suture is then meticulously placed to oppose the wound edges. The sutures are removed in approximately six days. Risks of suture-assisted resurfacing are similar to those of laser resurfacing. In addition, sutured areas may dehisce, or the wound edges may not oppose perfectly.
ELEVATED OR HYPERTROPHIC
FORMS OF ACNE
The above techniques are most applicable for the correction of indented and/or atrophic acne scarring.
The elevated or hypertrophic forms of acne scarring that most commonly occur on the chest, shoulders, back, or mandible are best treated with topical corticosteroids, intralesional corticosteroids, silicone gels/sheets, the pulsed-dye laser, or other vascularspecific lasers.
TAILORING TREATMENT
As with most of today's cosmetic procedures, clinicians and patients are discovering that the best results are often obtained by combining several modalities and tailoring the treatment to each individual patient.
Perhaps the best example of this approach is the suture-assisted resurfacing procedure, in which two separate strategies are employed on the same day. Other examples include subcision, fat transfer, or punch grafting months before laser resurfacing.
Microdermabrasion is a relatively new technique that involves the use of aluminum, salt, or diamond microparticles to bombard the skin and a suction apparatus to vacuum away the most superficial layer(s) of the epidermis. The results are extremely subtle and require many treatment sessions. Today, more acne scars are treated with laser resurfacing than with any other method. Laser resurfacing allows for more precise ablative control than do traditional techniques.
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