Acne- Causes and Treatments
Our skin has millions of oil glands that help protect our skin. Oil glands become blocked for many reasons: inadequate cleansing of the skin, failure to remove make up at bedtime, sensitivity to fragrance, diet high in fats, and/or excessive or thickening of gland secretions due to changes in hormones. I commonly recommend we work together with a dermatologist to get the acne under control for patients with active acne, especially deep cystic acne. Some of the basic acne recommendations do not involve medication, and are commonly overlooked by the patient.
1. Always wash the face before going to bed. Remove any makeup with a make-up remover and then wash again. Choose soaps that have little fragrance and that are not too harsh.
2. Change your pillow case at least twice a week. Oils and dirt from the hair build upon the pillow and can irritate the face.
3. Avoid fragrance (perfume, fabric softener, etc.) as the acne prone skin generally tends to be much more sensitive to it.
4. Watch what you eat. Many doctors tend to down play diet nowadays. I am old-school when it come to this area and believe that what goes in, must come out. I generally recommend avoiding dark colas, fried foods, milk, peanuts, and chocolate.
5. Choose hypoallergenic, non comedogenic moisturizers, sunscreens and make up. Patients with multiple deep cystic acne areas may benefit from the use of Accutane. This is a very strong, but dramatic treatment usually prescribed by dermatologists. Depending on the dose and length of treatment, Dr. Maloney generally recommends not having any surgical procedures for six to twelve months following the Accutane treatment.
The skin has two layers, an outer protective layer (Epidermis) and the supporting layer (Dermis). The main part of the oil gland is located in the dermis, with a small tube extending up through the outer layer to open on the surface. When the oil glands become blocked, they continue to secrete their oils (sebum). Eventually the gland bursts, exposing the oils to the surrounding cells. These oils are very irritating; therefore, the body sends the clean-up cells to remove all the damaged tissue. The end result is a weakening or loss of the supporting layer of skin, causing the outer layer to fall in, thus creating a depressed scar.
Scarring from acne can be narrow and deep, commonly referred to as ice pick scars, or broad and flat.
Many advances have taken place in the world of fillers. Collagen injections used to be the main filler. They were more of “an event” filler lasting a few months. The hyaluronic acid fillers such as Juvederm and Restylane are the latest in-office treatments for some acne scars. The fillers can be injected into certain acne scars to help level the skin surface. Deep ice pick scars, in general, do not lend themselves to this type of treatment. Broader scars typically respond better. Best of all, the correction may last up to a year for most patients.
Since the depressed acne scar represents a loss of the supporting layer, one treatment is to remove the damaged dermis and bring in healthy dermis. Punch grafts involve removing the depressed scar with a circular punch. Healthy skin, most commonly from behind the ear, is removed using a slightly larger punch. The healthy skin is placed in what used to be the scar hole. The graft is either taped or sutured in place. The tape or sutures are removed at the end of a week. Depending on the number and nature of the scars, several sessions of punch grafting may be performed. This procedure is most often followed by wire brush dermabrasion or carbon dioxide laser resurfacing to help smooth out any “circles.”
When a lot of scars are present, larger scar revision procedures such as the Wplasty,
Geometric Broken Line, or Zplasty may be helpful in creating a smoother skin surface.
Wire Brush Dermabrasion has been a valuable tool in the treatment of acne for over fifty years. It is not to be confused with micro-dermabrasion. Microdermabrasion is a procedure performed by aestheticians which works by removing some of the outer protective layer of the skin. Microdermabrasion is a nice tool to help “refresh” the complexion. Do not expect improvement in the appearance of the acne scars because it does not reach the deeper supporting layer where the problem is.
Wire Brush Dermabrasion is generally performed in the operating room by a surgeon. The skin is numbed with a local anesthetic. The spinning wire brush is used to remove the outer layer of the skin and a portion of the supporting layer. The end result is something that looks like a carpet burn.
Postoperative instructions follow a moist-healing protocol. Studies have shown that skin wounds heal faster when the surface is kept moist. The skin edges begin growing together, following a path of moisture. If the skin edges hit a crust they have to go under it, slowing the healing process. Patients are instructed to spray the dermabraded areas for fifteen minutes with a kitchen sink sprayer or shower, six times a day. After each spraying, the areas are gently dried and Aquaphor is applied. This protocol is followed daily for the first week. Generally by the end of the week, the new skin has matured enough to stop the spraying. A “bland” moisturizer may now be used as needed.
The CO2 laser is a focused beam of energy that removes the outer surface of the skin. It is a very controlled way to remove the outer scarred layers of the skin. A challenge, sometimes, with the CO2 laser is the patient with deep scarring, especially around the nose area. These patients may benefit from a combination of wire brush dermabrasion around the nose and CO2 laser on the rest of the face.
The exciting thing about acne treatments is that there are several options now for patients. Dr Maloney believes that every face is different and finds it important to customize a treatment program specific to each patient’s concerns and issues.
Maloney Center for Plastic Surgery- Atlanta,GA
Acne Scar Treatments
Fillers
Punch Grafts
Wplasty, Geometric Broken Line, and Zplasty Scar Revisions
Wire Brush Dermabrasion
Carbon Dioxide (CO2) Laser
