By Dr. Teo Wan Lin, Consultant Dermatologist at TWL Specialist Skin & Laser Centre
“Pock-marks, enlarged pores, uneven skin, congested skin …” Ever been told that by your friendly beauty advisors at the cosmetic counters pushing their magical products or by your facial auntie? Those pimply bumps that last for months, are they just scars that don’t go away? Or am I still having an acne problem in my 20s and 30s?
The countless advertisements from skincare solution providers. They started with just the beauty parlours but now has spread to ‘medical spas’ with doctors purportedly offering solutions to bad skin. How could one even start to differentiate what works from what doesn’t? Afterall, it never comes cheap.. And what more, with every single beauty or “medi-spa”claiming the “skin-specialist title?’’
Well if you ever felt confused by the sheer multitude of “acne scar treatment’’ providers, and “skin specialists”, in all honesty, as a dermatologist, I don’t blame you. I’ve been equally baffled by the proliferation of “skin specialists’’ in Singapore, all promising to make you beautiful, either with customised serums, peels or lasers, and of course, at a price.
On this note, if you’ve already decided you want some help for your skin, my role here is to formulate a quick guide (albeit slightly unconventional compared to your magazine beauty writers) as to how one can make an informed decision as to who to go to for skin treatments, and what the treatments are all about!
In the spirit of providing honest, unbiased objective reviews and advice from an insider point of view, I seek to shed some light on a dermatologist’s perspective on acne scar treatment in this article, which is the same kind of advice I personally give to my patients, friends and relatives.
1. Educate yourself first – science of acne scars?
I’m going to make a rather unusual illustration here and allude to how I purchased my audiophile sound system when I wasn’t exactly an audiophile.
I’m not sure about you but one of the ways I make decisions on a lot of things I buy, is really first to find out all the information out there. I try to understand myself how the “science behind it works”. I’ll let you in on this little secret on how to win my consumer heart: I usually am most impressed by a vendor that best explains how best that product fulfils a need in my daily life, for example, and actually being able to try it myself, rather than attractive packaging or freebies.
Along the way I go through a bunch of reviews on what actual consumers have to say about the product. Needless to say, all these are often what we find on the Internet.
I don’t stop there, I research the brand thoroughly, from the origins, the certifications, and well, generally if I’m looking for an audiophile sound system, I don’t go to a general electronics store selling washing machines and furniture to boot, or necessarily to the most beautifully built soundbox out there. For months, I spoke first to all the audiophiles I knew, read reviews on geek websites and auditioned several stores, trained my ears and finally decided on my final buy.
Honestly, I am thankful for all that. I have had so many different speakers before but 1000 of those could not compare to the single, solid, smooth system I have now. It wasn’t exactly the cheapest, but it was worth every single cent. Point is, as consumers, we should look for true value and substance, not marketing and packaging. It’s never easy in today’s world, but one way easy way is to check out certifications and do brand research.
Now, if that didn’t put you to sleep yet, let me translate that into the world of acne scar treatment.
Yes, research on the science of acne scar treatment all you want, but if you are like most people who want the very best results for their acne scar treatment, go to a dermatologist. Check on the qualifications of your doctor on the Singapore Medical Council website (https://prs.moh.gov.sg/prs/internet/profSearch/main.action?hpe=SMC) because they are the ones who know intimately the science and physiology of skin, and most importantly, have the experience and the know-how to avoid and manage complications which may arise from treatment.
2. Assessment – what type of acne scars?
Now, there are 2 types of acne scars — Post-Inflammation Hyperpigmentation (PIH) and dermal acne scars (otherwise known as ice pick, rolling or box car-type scars). It’s probably useful to know these terms which your dermatologist would tell you about in the discussion of your scar treatment.
What I share with my patients is this : Imagine your skin as having 2 layers, and now it has certain defects which are visible. Like a piece of pottery, PIH occurs in the top layer like the cracked glaze, while dermal scars in the second layer are like huge dents in the pottery which occurred during the moulding process.
Now if you were tasked to restore this clayware to its ideal form, what would you do? It’s intuitive to think one could paint over the cracks, or sand it off till it’s smooth. For the dents, well, how about filling it in with a huge clunk of new clay, maybe with superglue and paint it over again and pray no one would have noticed it.
A master potter, on the other hand, would assess first the defects and the overall aesthetic of the object. He will then determine how to most efficiently restore it without it looking artificial or fake, without damaging more parts of the clayware, and essentially, simply make it what it should look like — more beautiful.
Most importantly, the master potter understands the characteristics of clay when it is dry or when it is wet, the tools he has and how to use them. This is because he’s had years of experience training in that at far more complex levels. He also knows what it takes to make the final product look good, without making a bigger mess in the process. He would also be honest enough to tell you upfront if some defects simply cannot be corrected in a single treatment.
3. Tools for acne scars – Ablative CO2 fractional lasers? Chemical peels? Carbon peels? Radiofrequency? Skinboosters?
All of the above are clinically proven to improve the appearance of acne scars. Now what that means is that a body of evidence exists behind this, with clinical studies that support the use of these methods, and that a good proportion of dermatologists agree with these safety and effectiveness of these studies before the machines are cleared by FDA for the treatment of acne scars.
There are recommendations for settings which are given by the manufacturers, but far from being a cut-and-dried formula, the best effects are realised with the correct choice of treatment, the correct combination, timing as well as personal experience/expertise with the use of these machines, tailored to the individual patient’s skin type and response. Otherwise, a robot could also treat your acne scars, better still, without human error (pun intended).
Did you know, for example, that the darker skinned you are, the more heat from the laser your skin absorbs, and hence the higher the risk of scarring from treatments itself? This applies to all Singaporeans out there, whether you are of Chinese, Indian or Malay or any other asian heritage, you have much higher amounts of melanin (pigment colour in your skin) than your counterparts in Europe or America (where most of these technologies were discovered and used). It is important for your doctor to carefully watch how your skin reacts to the laser, to achieve the desired endpoint (which shows the treatment has reached an effective level) without causing unwanted heat damage.
I personally use a combination of treatments- from ablative (CO2 laser, plasma nitrogen) to non-ablative (radiofrequency) fractional resurfacing for deeper scars and for a more dramatic effect, in combination with a well-timed chemical peel/microdermabrasion to prep the skin for best results. Pigment lasers work well for uneven skin tone. For a finishing touch, skinboosters work well to create a plump dewy skin texture.
On the topic of tools, not all laser machines are created equal, as those which are of more sophisticated engineering tend to be more precise, cause less potential side effects and downtime. For example, higher-end CO2 laser machines are different in terms of delivery of the shape of the pulse, the wave type and overall precision in delivering energy to the deeper layers of skin without burning the surface of skin. These also incorporate radiofrequency energy to enable higher energy delivery without increasing the risk of heat damage to the skin.
Superficial chemical peels are the commonest used type of peels. They comprise primarily of one of or a combination of these 3 — glycolic acids, salicylic and lactic acids. These can cause excessive irritation if the concentration or type of acid used is inappropriate and may lead to chemical burns, or if too mild, are simply not effective.
4. Maintenance – Proper skincare
So you finally restored that piece of beautiful pottery. Subject it to wear and tear, rough handling and you will be back to square 1. There is a true science behind evidence-based skincare. Go for reputable, dermatologist recommended brands formulated in laboratories rather than what your facial auntie recommends you or what the latest customised serum fad offers.
Obviously the scope of acne scar treatment is well beyond that of any article. What I’ve set out to do is to streamline the key factors, the “know-how” rather than the “what”, which I believe can help the lay person navigate a bit clearer on this cloudy path. There are way too many vendors selling their wares to acne-scar sufferers, adding more woe to their already battered self-esteem. Hope this helps!
© 2017 Dr. Teo Wan Lin. All rights reserved.
Dr. Teo Wan Lin is a leading dermatologist in Singapore and also the Medical Director of TWL Specialist Skin & Laser Centre.Acne Scars