Acne Treatments (Acne Vulgaris Treatment)
Acne vulgaris is commonly referred to as acne, pimples, “zits” or blemishes
Most of us have, at one time or another suffered the effects of acne blemishes. It’s been reported that over 80% of people, between the onset of puberty and well into adult years, have experienced this condition.
The medical term for these blemishes is acne vulgaris and it is a common skin condition, caused by changes in pilosebaceous units. These units are skin structures consisting of a hair follicle and its’ associated sebaceous gland – the changes are cause by androgen (a steroid hormone such as testosterone) stimulation.
This condition takes the form of non-inflammatory and inflammatory skin eruptions (in its more severe forms). Acne vulgaris tends to more seriously affect the areas of skin with the densest population of sebaceous follicles. These areas generally include the face, the upper part of the chest, and the back. Acne lesions are commonly referred to as pimples, blemishes, spots, zits, or simply acne and can cause permanent scarring, in some cases.
Acne occurs most commonly during adolescent years while affecting more than 89% of teenagers, and frequently continues late into adulthood. Adolescence onset of acne is usually related to an increase in male sex hormones (testosterone) which is produced in higher quantities by people of both genders during puberty. For most individuals, acne diminishes over time and tends to disappear as hormone levels even off, after one reaches their early twenties.
This, however, is unpredictable and some will carry this condition well into their thirties, forties and beyond. There are many mistaken beliefs associated with acne. While good skin hygiene and over-the- counter skin care products can assist with this condition, the primary cause is hormonal. There are no scientific links, for example, between food and sunlight exposure and subsequent effects (positive or negative) on acne conditions.
In some instances of severe acne that is unresponsive to medications, a dermatologist (skin doctor) or cosmetic surgeon may be consulted to deal with scarring associated with this condition. Acne scars include raised (hypertropic) and depressed (atrophic,) scars which are the most common. Their appearances range from looking like a scar caused by a sharp, pointed object to a wide rounded-type scar.
Because there are different types of ace and acne scars, surgical revisions will depend on the type you have. A consultation with your physician can lead you through the many options available- for the best treatment for your particular situation.
The primary issues associated with severe acne are directly related to self esteem issues and social interactions. This is especially true of those who are going through puberty and are more vulnerable to negative emotions relating to feelings of self-consciousness. Treatment for acne scarring can, in many cases, alleviate these negative feelings and promote more positive social interactions.
Types of Acne Treatments
There are many available treatments for acne scarring and can include
• Chemical peels
• Laser skin resurfacing
• Soft tissue augmentation
If acne scarring is causing a major negative issue when it comes to self esteem and social interaction, then that person may be a good candidate for medical acne treatment (blackheads, whiteheads and larger spots on the face and sometimes on the neck, upper chest, back and upper arms) or scar removal. Please note that acne treatments are provided by both cosmetic surgeons and dermatologists. Your doctor can best provide the necessary information and make the appropriate referrals, if needed.
Chemical peels: in which chemicals are used to remove the top layer of skin in order to smooth the skin and even out any scar tissue. This can also give the skin a more even color and is most helpful in treating superficial acne scarring. The surgeon applies the chemical to the skin with an ordinary cotton tipped applicator, starting at the forehead and moving over the cheeks to the chin.
This is generally an outpatient procedure and can be performed with a light anesthetic. Different chemical compounds are used for different depth peels and light peel procedures require no healing time (while deeper peels often need up to two weeks to heal).
Laser skin resurfacing: is commonly used for reducing blemishes and removing acne scars. A laser skin resurfacing treatment can assist by removing the top layer of skin and stimulate collagen production deep within the skin’s surface.
This procedure involves a device which uses amplified light to vaporize the top layer of skin, which will allow new skin to grow. The three most common types of lasers used are the YAG laser, the carbon dioxide laser and the pulsed dye yellow light laser. This procedure is relatively intensive and most people will need a series of treatments to see results.
The laser stimulates the skin’s deepest layers to encourage healthy collagen growth and increase the rate of cell turnover. Lasers can also reduce the size of pores during treatment which results in less oil coming up through the sebaceous glands. This can keep skin cells healthier and make the skin stronger over time. Heating up the oil glands can be highly effective when treating active acne.
Advancements in laser technologies can also remove blackheads, pimples and reduce the size of cysts. Frequent exposure to the laser is a key to success for acne treatment, and both young and old acne sufferers can benefit from ongoing laser therapy - especially when it’s combined with a skincare regiment and healthy lifestyle. However, it should be noted that this form of acne treatment can be relatively expensive when compared to other acne treatment methods (See: Procedure Costs)
Dermabrasion: This refers to the mechanical sanding of the upper layers of the scar. A new layer of skin replaces the ground down (“abraded”) layer of skin. The technique, however, involves the use of a sanding device and can be relatively painful. Because of this, the procedure will require a general anesthesia or a twilight anesthesia (in which the patient is still partly conscious).
Afterward, the skin is very red and raw-looking, and it takes several months for the skin to completely re-grow and heal. Dermabrasion is useful for scar removal when the scar is raised above the surrounding skin, but is less effective with sunken scars. In the past decade, though, it has become more common to use laser skin resurfacing. Although more expensive, laser dermabrasion is much easier to control, much easier to gauge, and is practically bloodless compared to classic dermabrasion.
Microdermabrasion: In this procedure, tiny particles passing through a vacuum tube gently scrape away the top layer of scarred skin in order to stimulate new cell growth. Microdermabrasion (as opposed to standard dermabrasion) is indicated for patients with mild scarring. It should be noted that multiple treatments are usually required to achieve the best results.
For deep pitted scars, the physician cuts out the core of scar tissue with a small needle and sutures up the hole. During each session, a significant number of these scars are usually treated. An alternative to this step may involve replacing the excised part with a small graft of normal skin, (often taken from behind the ear) and then taping it in place.
Microdermabrasion is painless; being less invasive compared to classic dermabrasion and laser treatments and is more affordable. It has fewer side effects and can be performed without anesthesia if performed at a spa, beauty salon or physician’s office.
Soft tissue augmentation: This procedure uses an injectable filler and is useful for shallower acne scars. The fillers, however, are not permanent and typically last anywhere from a few weeks to nine months. Some of the newer fillers, though, like Restylane® and Hylaform® can last two to six years after the injections. Most of these fillers work by stimulating your body’s natural collagen around the injected filler and plumps up the area injected. This is performed as an outpatient procedure with little discomfort involved.
In some cases, the scars are treated with fat grafting, which is a technique that takes fat from other areas of your body and then injects it into the scars, filling out the depressed areas. The effects of fat injecting tend to be longer lasting with less chance of rejection that can sometimes result from foreign material introduction.
Photofacials: These are generally used to help reduce fine lines and wrinkles while evening out the skin tone and improve the complexion. However, they can also be effective at decreasing the rate of acne breakouts and tightening up the pores. The procedure involves combining red and blue light energy waves and can help rejuvenate and repair damaged skin so that acne breakouts are much less frequent.
Over time, the skin also becomes stronger and less susceptible to blemishes and acne breakouts. Photofacial rejuvenation treatments are becoming more and more accurate and effective for treating skin tissues.
Since the light is delivered in a targeted manner, the treatment has a low risk of aggravating and damaging surrounding skin tissues. The procedure is performed on an outpatient basis and most people experience results after just one treatment The most common side effects to photofacial rejuvenation include light swelling and redness that usually disappears within a few hours.
Most acne treatments are performed on an outpatient basis and don’t require extensive recovery. The main exception to this is a dermabrasion procedure which requires a more intensive anesthetic approach and involves more bleeding. The healing time for a dermabrasion can be many months as opposed, for example, to a photofacial which tends to heal in a few hours.
The invasiveness of the procedure will determine recovery times and should be discussed with your doctor. In all cases, instructions will be given by your doctor that need to be followed exactly and will generally include items such as avoiding exposure to direct sunlight.
Risks Associated With Acne Treatments
The risks associated with acne treatments, of course, depend on the actual procedure. An overview follows but is not to be substituted for a consultation from a qualified physician.
Chemical peels: Chemical peels rarely result in serious complications, but there are certain risks. These risks can include scarring, infection, swelling, changes in skin tone, and cold sore outbreaks. You can reduce the risks associated with facial peels by following all of the doctor’s instructions completely and by providing your doctor with a complete medical history.
Laser skin resurfacing: Possible adverse reactions include excessive scarring, infection, loss of normal skin pigmentation, skin redness and dryness, and others. These reactions can be minimized according to the skill level of the doctor performing the procedure. However, even if you are treated by a highly skilled professional, reactions can occur.
In particular, people with darker skin are more likely to develop uneven pigmentation whereas people who were on Accutane® (a common acne treatment) or those with certain connective tissue disorders are more prone to scarring. Various inflammatory skin conditions can increase the risk of adverse reactions and laser peels can, in some cases, activate herpes virus and possibly activate other dormant pathogens. In most cases, a patient is given an oral antiviral drug and sometimes antibiotics before and after the procedure.
Dermabrasion: Potential risks with dermabrasion vary from patient to patient. The standard risks are excessive bleeding, infection and an adverse reaction to anesthesia. Certain patients are more prone to various skin growths (keloids) or developing excessive scar tissue or hypertropic scars. These are usually treated with the application or injection of steroid medications to soften the scar tissue.
Patients who are prone to skin growths, are generally not good candidates for the surgery. Although, it is the responsibility of the physician or cosmetic surgeon to note that possibility during the time of the initial consultation. Also, during the consultation, a dermabrasion surgeon should note if the patient experiences frequent herpes simplex infections (cold sores). These viral infections can be aggravated by the dermabrasion procedure. Prior to the surgery, the physician will prescribe a course of anti-viral medication in order to avoid this risk.
Whitehead formations can also occur and will usually disappear on their own or can be removed with the use of an mildly abrasive pad or soap. Occasionally, though, the surgeon may have to remove them. A few patients may develop enlarged skin pores but these usually shrink to near normal size once the swelling has subsided.
Another risk that can occur with dermabrasion is thickening of the skin as a result of new skin growth after the procedure. However, this is rarely a severe problem and can be treated with injections by the physician or cortisone creams.
Microdermabrasion: There is only one common, though minor, risk associated with microdermabrasion and is related to skin color balance (in other words, you may get dark or light patches from micro dermabrasion). The reason the risk is so small with microdermabrasion is because it’s a relatively non-invasive procedure that only removes the top layer of skin (which is formed only of dead skin cells). This leaves the live tissue underneath intact.
Soft tissue augmentation: Risks can include shifting or clumping of the filler material - surgical removal may be necessary to correct these lumps or nodules. Infection and bleeding, which is standard for all invasive procedure, may occur. Skin sensitivity or skin rash may also develop.
Photofacials: This procedure has fewer long term side effects. Short term side effects include increased visibility of small capillaries, redness and swelling. All of these, however, begin to fade relatively quickly—a few hours—after treatment has been completed.
Rare incidents of bleeding and blistering, along with discoloration of the skin have been noted. Scarring is also possible, but rare.
Skin cancer, pregnancy, keloid formations (raised scarring that is excessive), and open legions can prevent safe receipt of treatment for the patient. It is imperative that current medications and patient medical history is discussed your plastic or cosmetic surgeon before treatment begins.
Costs associated with various acne treatments can vary widely, depending on a number of factors. These factors can include (but are not limited to): doctor fees, anesthesia, material costs (such as chemicals used in peels), facility fees and variations in rates by region economics. It’s very important to discuss the total procedural costs with your doctor. This should include a discussion of any follow up visit costs that may be necessary (especially with laser treatments).
According to the American Society of Plastic Surgeons, the average cost of chemical peels in the U.S. is between $500 and $600; laser skin resurfacing runs between $2300 and $3200 while dermabrasion runs about $1000. Soft tissue augmentation costs an average of $371 while fat injections usually run a little over $1000.
Other sources indicate that microdermabrasion procedures usually run between $75-$300 (depending on whether it’s performed in a spa or a doctor’s clinic). Photofacial costs can run between $300-$600 per treatment.
10 Things to Discuss with Your Surgeon During Your Consultation
• What are the realistic expectations associated with my recommended pro?
• Where are the acne procedures to be performed and is the facility accredited?
• In my case, what technique is recommended how is it performed?
• What kind of anesthesia will the surgeon use during the surgery?
• What are the total procedural costs (including subsequent visits) and what is the cost breakdown?
• What is the surgeon’s level of experience in performing the procedure?
• What percentage of patients experience complications and what are the most common complications?
• What is the surgeon’s policy in regards to correcting or repeating the procedure if the treatment does not meet agreed upon goals (costs, etc.)?
• What should I expect, after the procedure, in terms of soreness, additional scaring, activity level and so on?
• Have you ever had your malpractice insurance coverage denied, revoked or suspended?