Acne scarring can be a disfiguring and embarrassing condition that, up until recently, has been very difficult to treat. It is caused by severe, chronic, and acute or chronic acne lasting many years. As it progresses, it can leave typical scarring behind; some shallow craters, some deeper craters, and some sharp and deep craters, known as ice pick lesions.
Impact Acne & Reduce Scarred Skin
We combine a course of two or three TCA (trichloroacetic acid) peels with up to three Morpheus8 treatments, and find this can make quite an impact on acne scarring. This can also include a quick treatment called subcision. This involves releasing the tethered appearance of a scar using a fine needle and is done with local anaesthetic at the same time as the Morpheus8 treatment. Peels can also be very useful in treating active acne.
How Does Morpheus8 Work For Acne?
Early treatments for scarring removed the entire superficial surface of the skin; as the skin grew back, scarring was reduced, but the new skin was overly pale and plastic-like as all the pigment producing cells (the melanocytes) had also been removed. The logical progression was to fractionate the treatment to remove some of the acne scarring but leave behind healthy normal skin which contained melanocytes etc. These would then multiply and grow into the resurfaced areas and the result was resurfaced skin which looked much smoother and more normal. Morpheus8 can be used as an RF needling (fractionated treatment) which gives excellent results in reducing scarred skin. In addition, this stimulates the dermis to produce more collagen and elastin. The deep skin regains volume and the overlying skin looks fresher, smoother, with more even pigmentation.
The History Of Skin Resurfacing
In the past, attempts were made to resurface the skin. This was initially done (under general anaesthetic) with sterile sandpaper. It was calleddermabrasion and is not to be confused with micro-dermabrasion found today being offered in salons. The problem with acne scarring is that no amount of gently removing the very top ‘dead’ layers of skin will help. And this is all microdermabrasion will do. It cannot remove living skin and this is what is needed to remodel the scars.
Although dermabrasion was successful in reducing the size of the lesions, it wasn’t terribly accurate in the depth of the skin removed and, consequently, scarring could occur which was every bit as bad. The main problem with this though, was that becauseallof the top layer of the skin was removed (including the healthy, unscarred skin and the melanocytes which give the skin pigment), the skin which healed after the treatment looked abnormally pale and, sometimes, plasticky in appearance. The next step in improving the accuracy of the depth of the skin removal came when lasers were used. The most common being the CO2 laser. And although it was more accurate, it still removed the whole of the top layer.
The logical progression for skin resurfacing was to fractionate the treatment. To remove some of the acne scarring, but leave behind healthy, normal skin, which contained melanocytes etc. These would then multiply and grow into the resurfaced areas and the result was resurfaced skin, which looked much smoother and more normal. The fractionated CO2 lasers included Fraxel and they have been used now as a standard, basic resurfacing treatment for several years.
Radio frequency treatment
The next step in the development offractionated resurfacing was radio frequency treatments. They have the advantage over the CO2 treatments of having thermal contraction of the skin as part of the outcome. We have one of the most advanced in Morpheus8 , which has developed from the fractionated treatment , Fractora. In treating acne scarring, I find that combining a course of several TCA peels with one or two Morpheus8 treatments can make quite an impact on acne scarring. It can also be very useful in treating active acne.
Medium peels are excellent in the treatment of acne scarring and can be safely used during active acne phases where the results can be quite dramatic.
We use TCA (trichloroacetic acid) peels for our medium depth peels. They come in 3 strengths, 15%, 18% and 20%. They are quick treatments, taking 30 mins in total.
Having prepared the skin with a deep cleanse, the TCA is applied and left on the skin (with a fan for cooling) for 1-2 minutes. A neutral is then added and left on for about 12 hours to allow the TCA to work fully. There is a down time with this peel.
On the day of the peel, the skin is red and looks like sunburn. The following day, this redness persists and the skin can look quite dry and needs regular application of moisturiser. The day after that, the dryness is more apparent and peeling may start. This is the least attractive day! By day four, peeling has started and by day five it is nearly always complete, revealing fantastic brand new skin.
These peels will give a much better result after four courses.
TCA peels from £125 each.
Morpheus8 from £750 for the first treatment, and from £650 for the second.