Acne scars on dark skin as a matter of principle are the result of a treatment failure in cases of active acne. When do scars in skin result at all ? Acne scars, like all other scars in the skin, are the result of injury to the dermis, which begins a couple of micrometers below the skin surface. The hair follicle, which is the primary site of acne lesions, reaches through the dermis into the deeper tissues with a microscopic opening to the outside. Damage to the hair follicle severe enough to result in a scar leads to acne scars.
Thus the key is really prevention. Acne scars on dark skin are disfiguring and their treatment in dark skin types is fraught with problems. Everything has to be done to prevent acne lesions to arise, to progress to the stage where the infection of the hair follicle (the actual term is pilosebaceous unit as hair and oil glands form a unit) is so severe that destruction eventually results in acne scars.
Medical management of active acne rests on three pillars – lifestyle modification, hormonal balancing and local and systemic medications. Unfortunately, in our Caribbean plastic and cosmetic surgery practice at Trinidad Institute of Plastic Surgery it is rare that we see these treatments executed precisely and competently. This has several reasons. A paucity of competent and qualified dermatologists and plastic surgeons (e. g. properly trained, board certified), who are the usual experts on skin care, lack of education and knowledge of those afflicted with acne and their reluctance to commit time and financial resources to treatment of acne in order to prevent acne scarring. The consequences are a more difficult and expensive problem – acne scars on dark skin.
So what to do once acne scars on dark skin have developed ? The treatment of acne scars on dark skin is made a bit more difficult due to the fact that “hot” (CO2) lasers, which are the first line option in light skin, are not applicable due to the pigment loss and irregular pigmentation they cause as a consequence of the heat generated killing a lot of pigment producing cells during planing of the skin with acne scars.
Classical dermabrasion performed with mechanical diamond brushes is an excellent alternative. It requires an operating room, but can be performed under local anesthesia and nerve blocks with a couple of days of recovery time during which the surface of the skin heals. As opposed to laser resurfacing it requires a highly skilled and experienced operator.
Sandabrasian uses medical sanding paper instead of a mechanical dermabrader with brushes, but also relies on the idea of planing of the skin afflicted with acne scars. The margin for error is somewhat increased compared to mechanical dermabrasion and the equipment is also less expensive. It is an office procedure performed under facial nerve blocks with the same or somewhat shorter recovery period as classical dermabrasion.
Medium depth chemical peeling with TCA (trichloracetic acid peels, most frequently used in the form of the Obagi Blue Peel) is another option with a satisfactory success rate in superficial to moderately deep acne scars on dark skin. TCA peels reach the mid dermis, induce new collagen formation, contribute to planing of the irregular surface and can be done under nerve block anesthesia in an office setting. Like mechanical dermabrasion they require a considerable degree of experience by the operator, but are generally safe (as opposed to deep phenol peels) in dark skin tones, meaning they generally improve pigmentary changes, decrease pore size, improve texture and have a very low risk of unfavorable scarring. Innovative treatments can be used.
Skin regeneration is the truly hot topic in acne scars skin treatments – stem cell transplantation with lipofilling and structural fat grafting, platelet rich plasma and percutaneous collagen induction therapy with or without substance induction, amongst others.
It is important to realize that once acne scars occurred in dark skin there is no silver bullet anymore to predictably solve the problem. None of the skin treatments are cheap or have a uniform success rate. One may have to try out modalities to arrive at a conclusion what works best in the individual client to ameliorate the aesthetic effects of acne scars. The effects of these treatments, however, is backed by science and experience of serious professionals like plastic surgeons.
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Trinidad Institute of Plastic Surgery – the superior choice for acne scars on dark skin treatment in the Caribbean, Antigua and Barbuda, The Bahamas, Barbados, Belize, Dominica, Grenada, Guyana, Haiti, Jamaica, Montserrat, Saint Lucia, St. Kitts and Nevis, St. Vincent and the Grenadines, Suriname, Trinidad and Tobago, Bermuda, British Virgin Islands, Cayman Islands, Turks and Caicos Islands, Miami, New York, Toronto, London