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craters, explains Dr Al-Niaimi. Another form of acne scarring is hypertrophic, which presents as thick, raised, and red in colour. These are rarer and often found on the body, as opposed to the face, Professor Al-Niaimi explains. Although understanding the different types of scarring is helpful, Professor Al-Niaimi adds that many patients actually present with a combination of all three types of atrophic scarring, and so your treatment plan will often need to address all three. He notes that there are a range of factors which can result in scarring, stating that it isn’t always predictable. “In terms of severity, acne can be categorised from mild to severe, with the latter being the most likely for causing acne scars,” Professor Al-Niaimi says, adding, “However, this isn’t always an indicator, and a family history of acne and acne scarring can also play a factor, as well as whether the acne was left untreated or whether the patient squeezed or picked at their spots while the acne was active.”
Addressing Acne Scars with Lasers Three practitioners discuss their approach to improving acne scarring using lasers Acne vulgaris is a common skin condition affecting up to 80% of young adults and adolescents, although it can be seen across all age groups.1 According to the NHS, about 3% of adults have acne over the age of 35.2 The presence of acne can come with many side effects and complications, with the most common being scarring. One UK study estimated that 0.7% of people with acne have severe acne scars, but some degree of scarring is estimated to occur in up to 90% of patients with acne.3 Scarring can be treated in a number of ways, for example by using topical skincare, dermabrasion, laser resurfacing, dermal fillers, non-ablative and fractional lasers, chemical peels, or any number of combination treatments. With the constant development of laser technology in aesthetic medicine, Aesthetics spoke to three practitioners about some of the newest devices on the market, as well as their preferred treatment approach for improving acne scarring.
Types of acne scarring When assessing different types of acne scarring, generalised atrophic scars are the most common form seen on the face, explains Professor Firas Al-Niaimi, consultant dermatologist and laser surgeon at the Dr Firas Al-Niaimi clinic, London. He notes that there are three main types of atrophic acne scars (Figure 1). These can be categorised as ice pick scars – small and deep holes in the surface of the skin; rolling scars – caused by bands of scar tissue that form under the skin, giving the skin a crepey appearance; and boxcar scars – round or oval
Icepick scars
Rolling scars
Figure 1: The different formations of acne scars
Boxcar scars
Hypertrophic scars
The psychological impact All three practitioners note that acne scarring can have a significant negative impact on patients, and studies on the psychosocial impact of acne have documented dissatisfaction with appearance, embarrassment, self-consciousness and lack of self-confidence.5,6,7 This has an impact on the consultation and treatment plan, explains Mr Rishi Mandavia, ENT surgical doctor and managing director of the Dr Tatiana Aesthetic Dermatology Clinic. He explains, “Our appearance has a big impact on the way we feel about ourselves, especially nowadays, with the rise in social media. The reason scarring affects our patients psychologically is because it’s something that’s very difficult to cover up, even with makeup. In my clinic, we carry out quality of life surveys and we really do notice a huge difference in the way that our patients feel before and after treatment. It’s something that plays a big factor in self-confidence.” Professor Al-Niaimi advises that this psychological impact is something practitioners should consider when discussing specific treatment plans and methods with their patients. He comments, “Someone might have what a physician would class as a ‘mild form’ of scarring, however it might have a resounding negative affect on the patient’s quality of life. In contrast, there could be someone with severe acne scarring, but they aren’t
Reproduced from Aesthetics | Volume 8/Issue 9 - August 2021
