Which is the best method to treat boxcar acne scars? (photo)
I would like to find out what are the best methods to treat boxcar acne scars, as seen on my face? Thank you.
The best methods to treat boxcar acne scars in Singapore involve a combination of lasers, chemical peels (TCA Cross) and manual subcision with fillers.
Identifying the right treatment for each type of acne scar and using a combination of modalities can yield the best results. Don't be worried! There are multiple safe, effective, and cost-effective options are available for the treatment of acne scarring.
You have a combination of Boxcar acne scars and Ice pick acne scars.
What are Ice-pick Acne Scars and Box-scar acne scars?
Ice pick scars are characterized by small, deep holes in the skin with a wide opening and a narrow base.
Boxcar scars are square or U-shaped depressions in the skin.
Why is the diagnosis of the scar type important?
Scar morphology is a key driver of treatment options.
What are good lasers for treating deep boxcar acne scars in Singapore?
Good lasers include: Fractional CO2 and INFINI Fractional RF.
For very deep boxcar acne scars, punch excision and grafting are particularly effective when combined with laser resurfacing.
TCA Cross is another good scar revision treatment. Histologically, acne scars show a reduction in collagen and elastin. Chemical reconstruction of skin scars [CROSS] is a technique of applying high concentrations of trichloroacetic acid [TCA] to atrophic ice pick scars to induce inflammation and collagen production. The CROSS method causes coagulative epidermal necrosis and collagen necrosis in the papillary and upper reticular dermis, resulting in scar remodeling over time.
How do I find a good acne scar doctor in Singapore?
The key to getting a good result for acne scar treatment in Singapore is to find a doctor who is meticulous and who targets each type of scar specifically.
Cost-effectiveness is another important factor to consider. Find out more about the price/cost of acne scar treatments in Singapore in this article.
Hope this helps!
Dr Justin Boey
Acne scars can be classified into hypertrophic or atrophic in nature. Hypertrohic scars are usually thickened and raised lumpy scars, which are usually more common over the chest and back, but can occur over the face as well. With regards to the face, 80-90% of the time, atrophic scars are formed as a sequelae of acne. This is due to the aberrant production and degradation of collagen during the inflammatory and healing process of acne, which leads to a net destruction of collagen and loss of volume. Atrophic acne scars include ice-pick, rolling and boxcar scars, based on their depth and size of destruction.
Boxcar acne scars can be treated with resurfacing lasers such as fractional CO2 laser, radiofrequency micro-needling(INFINI) to induce collagen production and volumisation of the scar, as well as using Picolaser(PICOSURE)'s Diffractive Lens Array(DLA) technology to create Laser Induced Optical Breakdowns(LIOBs) beneath the surface of the scar. This creates a powerful stimulation of the healing cascade which allows the skin to rejuvenate and heal/repair scars by formation of new collagen and elastin, but with shorter downtime and discomfort. This is also suitable for rolling scars and ice-picks scars.
Ice-pick scars are best treated with TCA CROSS, chemical peels and in some instances, punch excision. Rolling scars are best treated subcision, radiofrequency micro-needling(INFINI), fractional lasers. And as mentioned above, rolling scars and ice-pick scars show marked improvement with the new Picolaser(PICOSURE)'s DLA technology. Shallow atrophic scars can also be treated with fillers after improvement with the above modalities.
In my practice, I adopt a combination therapy approach and employ different treatment modalities to treat acne scars. From the picture, you do have a combination of a different scar types and you should get a proper assessment by an experienced doctor who will discuss with you the best options to treat your scars.
Thank you for your pictures. You seem to have a mix of box and ice-pick scars. I'd use mainly combination lasers for that, including some ablative lasers. This still depends on personal assessment and your skin type.
Additionally, some deeper scars will benefit from punch excision and microsurgery to completely remove.
Stay away from microneedling radiofrequency - they do not work at all for your type of scars.
Hope this helps!