Acne/Scarring

What causes acne?

Acne is caused by a combination of genetic, hormonal and local factors. There is now good evidence that acne can be related to diet. Please see Nutrition for the Skin, below. In particular, it is advised to increase omega 3 oil intake, eg. Salmon, sardines, omega 3 fish oil capsules, flaxseed oil; and to avoid high Glycaemic Index ( GI) foods such as white bread, potatoes, white rice and sweets.

What produces acne?

1. Hormones increase oil production. Genetic factors can also lead to increased oil production.
2. The oily secretions often block skin pores causing blackheads.
3. Bacteria live in oily secretions. If the pores are blocked, the bacteria multiply and produce inflammation = pus heads.
4. Squeezing pimples causes the inflammation to spread deeper into your skin. This can lead to acne scarring.

What cleansers can I use?

Non greasy oil free cleansers are best. These include:

1. Neutrogena Oil Free Cleanser
2. Cethaphil Cleanser
3. Neutorigena Blackhead Skin Cleanser
4. Neostrata glycolic acid oily skin solution

What moisturiser can I use?

Heavy moisturizers and sunscreens are best avoided as they cause skin clogging. Oil free moisturizers can be used sparingly. Theses include:

1. Skin Tech Refining Gel
2. Neutrogena for combination skin
3. Gel based moisturizers.

What sunscreen can I use?

It's best to avoid most sunscreens unless they are a GEL BASE. e.g. Ego Sunsense Clear Gel.

What foundation should I be using?

If foundation is to be used it should be oil free. Most brands have oil free foundations, which are labeled as “oil free”.

1. Antibiotics

Antibiotics taken by mouth or applied to the skin, are helpful for acne. However resistance to antibiotics may occur in the long term.

2. Glycolic acids

Glycolic acid washes, gels and peels are useful for treating active acne. On the other hand, glycolic acid creams may aggravate acne, and should be avoided (as the cream base blocks the oil glands).

3. Vitamin A derivatives

Oral Vitamin A derivatives are useful for more severe forms of acne, and produce long lasting improvement. These treatments have a number of side effects, many of which are dose related. Topical Vitamin A derivatives are also useful, but can initially cause irritation.

4. Other Creams

Other creams (eg- benzoyl peroxide, and salicylic acid) are also useful.

5. Microdermabrasion

This is a non-invasive procedure that helps with mild acne and acne scarring. Aluminum oxide crystals are rubbed onto your skin under negative suction pressure removing the top layer of the skin, and “opening up” the acne lesions, stimulating the healing process. Several treatments are needed to obtain the best results, and can be combined with glycolic acid peels.

6. Hormones

Hormone therapy such as the oral contraceptive pill may be useful for hormonal acne.

No Need to Put Up With Acne

Acne is caused by a combination of genetic, hormonal and local factors. Diet may be a factor in some cases.

It may be aggravated by use of moisturizers, moisturizing sunscreens, and oils applied to the skin.

What treatments are available?

There are many treatments for acne depending on the severity. These include:

Glycolic Acid gels and Peels

Benzoyl Peroxide

Antibiotic gels and liquids

Antibiotic tablets

Vitamin A derivatives

Photodynamic therapy

This is a very effective treatment for acne. It involves use of a liquid and then exposure to Blu or red Light. Most people need a few treatments and this can be combined with other therapies. Blu light is safe and is not like ultraviolet light. Blu light does not cause sun damage, wrinkles or skin cancer. Following Photodynamic therapy, the skin is sensitive to sunlight for 48 hours.

Microdermabrasion

This is a safe, simple, painless, non invasive treatment where crystals are rubbed onto the skin to remove dead cells and unclog pores. It is combined with a light glycolic acid peel. It is helpful for acne and acne scarring. Under medical supervision it can be used in conjunction with oral treatments. Approx cost is $150.

Microdermabrasion & Blue Light therapy

This helps to kill off the bacteria in acne lesions. Approx cost is $250.

Hormone Therapy

What skin care should be used?

In general, it is best to avoid creamy moisturizers and sunscreens. Oil free makeup and gel based sunscreens are better. Avoid vitamin E oil and cream.

Our clinic can recommend certain brands of makeup and skin care.

We are able to perform all the different treatments at competitive prices

Acne Scarring Treatments

Acne may leave scars and marks, which may be temporary or permanent. There are a number of treatments which can improve acne scarring.

1. Microdermabrasion

More about Microdermabrasion...

Microdermabrasion is useful for mild acne scarring, especially for the red or brown marks. It is less useful for pitted or depressed acne scarring. Several treatments are usually needed. Following treatment there is usually mild redness, which lasts for a few days. Microdermabrasion can be combined with glycolic, salicylic and lactic acid peels for improved results.  

2. Fraxel Laser Treatment

More about Fraxel Laser Treatment...

FRAXEL Laser Treatment produces thousands of tiny but deep columns of laser light into your skin, known as microthermal treatment zones. The laser beams penetrate deeply into the acne scars leading to new collagen formation, which in turn fills out the acne scars. At the same time the surface layer of the skin remains intact and unaffected. This "fractional" treatment allows your skin to heal much faster than older laser procedures.  Improvement in acne scarring with the Fraxel is considered to be better than any other laser procedure. Fraxel is suitable for all skin types.  

3. Pulsed Light Therapy

More about Pulsed Light Therapy...

Pulsed light therapy is a non-invasive treatment, which is useful for improving red or brown acne scarring. Usually 2-5 treatment sessions are needed to achieve optimal improvement. Following treatment the scars are redder or darker for 5-7 days before lightening occurs.  

4. Filling Agents

More about filling agents...

Injection of filling agents can be useful for some depressed acne scars but not for pitted scars. Filling agents may be temporary or permanent. These agents are safe, but in rare instances allergic reactions or infection can occur. The end result can be an improvement in skin contour.

5. Laser Resurfacing

More about laser resurfacing...

Laser resurfacing is commonly used for acne scarring. Usually the Erbium YAG laser or CO2 laser is used, and the top layers of the skin are removed. New skin forms after 7-10 days, while improvement in the acne scars occur over the following 3 months.

Laser resurfacing is a relatively invasive procedure requiring 10-14 days off work, followed by redness, which lasts at least 6-8 weeks. Because it is not possible to Laser down to the level of the acne scarring, improvement is limited to approximately 40-50% improvement. Results can be further improved with the use of filling agents. There are a number of risks associated with laser resurfacing including changes in skin pigment and scarring.

Fraxel

A Major breakthrough in the treatment of Acne Scarring and other Skin Conditions

Acne scarring can be extremely disfiguring and until recently has been very difficult to treat. The Fraxel and Fractionated Skin Resurfacing have revolutionized the treatment of most forms of acne scarring for the face, neck chest and back.

How does Fraxel work?

The Fraxel is a unique non invasive laser technology, which produces columns of laser beams which penetrate deeply in to the skin reaching the base of the acne scars, and producing new collagen formation. This in turn “fills up” the acne scars, making them smoother and shallower.

Because the treatment is fractionated, it selectively treats the acne scars, without damaging the surface layer of the skin, so there is no open wound.

The Fraxel laser penetrates more deeply than previous lasers used for acne scarring e.g. CO2 laser, but heals faster Makeup and usual skin care products can be applied the day after treatment.

How much improvement can be expected with the Fraxel laser?

The improvement in acne scarring will depend on the strength of the Fraxel treatment, the number of Fraxel treatments, and the severity of the acne scarring. Stronger Fraxel treatments will produce greater improvement, but have longer “down time”. In most people it is possible to achieve 60-80% improvement in acne scarring with stronger Fraxel treatments. Previous treatments for acne scarring achieved about 20-40% improvement in acne scars.

How many treatments of Fraxel are needed?

The number of Fraxel treatments will depend on the severity of the acne scars, the strength of the Fraxel treatment sessions and your expectations. Most people have 4-5 Fraxel treatments, but it is possible to achieve significant improvement in acne scarring with 2-3 sessions. Some people have more than 5 treatments, and continue to improve their acne scars and skin texture.

How long between Fraxel laser treatments?

There is no set time between Fraxel laser treatments. It is usually recommended that treatments be performed every 2-4 weeks. However it is not a disadvantage to wait longer between Fraxel treatments.

Does the Fraxel hurt?

The amount and degree of discomfort are related to the strength of the Fraxel treatment. Lower intensity, weaker treatments hurt little, while stronger treatments are potentially more painful. In order to minimize discomfort, a numbing cream is applied for at least one hour prior to treatment. In addition, it is also helpful to have some local anesthetic injections, so that the areas of acne scarring are numb and no pain is felt. In addition, you can also have Pain puffers, and other painkillers if needed.

How long does the Fraxel treatment take?

Before the Fraxel treatment is started, a numbing cream is applied for at least 1 hour. After this the treatment usually takes about 1 hour. Most people can drive home after the treatment, unless a pain puffer or injectable pain killers are used.

What will I look like after the treatment?

After the Fraxel treatment, it is usual to be slightly red and swollen for 2-3 days. With stronger treatments, redness may last a few more days.

Makeup and skin care can be used the day after treatment. Some people also have peeling of the skin for a few days, and occasional scabbing. It is important to avoid using too much or too greasy moisturizers and sunscreens after the treatment, otherwise acne lesions may appear. A light moisturizer and oil free sunscreen may be used sparingly.

People with darker skin, may need to use a depigmenting lotion after the treatment, in order to prevent temporary post treatment increase in skin pigmentation. The Depigmenting lotion will cause some redness and peeling while it is being used.

When can I return to work after Fraxel treatments?

Most people can return to work after a few days depending on the strength of the Fraxel treatments. With stronger treatments, redness may last longer.

What skin care is needed after Fraxel laser treatments?

After Fraxel treatment, people can use their usual skin care products and makeup. Although sunscreens are recommended, it is important to avoid creamy or greasy sunscreens, otherwise acne lesions may develop. Oil free sunscreens and makeup are best.

Vitamin A creams e.g. Retinol can be used after the Fraxel treatment to further stimulate new collagen and improvement in the acne scars. However Vitamin A creams may cause pinkness and peeling of the skin especially when they are used for the first time. It may be best to use them once every 2nd or 3rd days initially. It is best to avoid vitamin E creams and oils as they can cause pimples and blemishes If a depigmenting lotion is needed, some moisturizer is needed, as the lotion causes dryness and some peeling. An oil free lighter moisturizer is recommended for acne prone skin.

Can Fraxel laser be used whilst on RoAccutane therapy for acne?

The use of lasers in conjunction with Ro Accutane is controversial. Some lasers e.g. Erbium and CO2 are, generally not recommended while on RoAccutane, other lasers and light sources e.g. Laser Hair removal

Pulsed Light can be used. There is no good medical evidence to suggest that Fraxel cannot be used while on RoAccutane. Our clinic has found that it is safe to use Fraxel and RoAccutane at the same time.

Are there side effects of Fraxel Laser treatment?

There are few side effects with Fraxel Laser treatment but may include:

1. Prolonged Redness. While redness is usual for a few days after Fraxel treatment, some people may experience prolonged redness. It will eventually settle in nearly all cases. Prolonged redness may also occur if vitamin A creams and depigmenting lotions are used after treatment.

2. Scabbing. Light peeling and scabbing may occur after treatment for a few days. It will resolve.

3. Swelling. This is normal for a few days after the treatment. You may wish to take some Prednisolone tablets after the treatment to reduce swelling.

4. Increased Skin Pigmentation. Temporary increase in skin pigmentation may occur in people with olive or darker skins, or those who expose their skin to sunlight after treatment. In order to prevent this, a depigmenting lotion is used routinely in people with olive or darker skin immediately after Fraxel treatments. An oil free sunscreen is also recommended after Fraxel treatment.

5. Scarring. This is rare. If it does occur, it usually appears as a red thickened area. It can be successfully treated with injections of 5FU or cortisone.

6. Decrease in Skin Pigmentation. In some cases, there may be a slight decrease in skin pigmentation. It may be due to loss of sun damage.

7. Infection. This is rare. However, cold sores may occur after Fraxel treatment, if there is a previous history of cold sores. This can be prevented by using anti cold sore tablets.

8. Recurrence of Acne. If excessive moisturizers or sunscreens are used after Fraxel, acne may occur. What is the Cost of Fraxel Treatments? Fraxel treatments vary from about $600-$1255 per area per session.

What else can Fraxel be used for?

Fraxel lasers can also be used for:

1. Sun Damage and wrinkles

2. Pigmentation

3. Stretch Marks

4. Other scars e.g. Post surgery, post trauma, and burns.

What other treatments are available for Acne Scarring?

1. Microdermabrasion

This is a non invasive treatment where a machine rubs aluminum oxide crystals onto the skin to smooth out acne lesions and mild scarring. It is not painful, takes about ½ hours, and allows you to return to work and normal activities the next day.

It is usually combined with a light glycolic acid peel to further improve acne lesions and scarring. The approximate cost is $150 per session. You may be able to claim some back from Medicare.

2. Injectable Fillers

Some acne scars are suitable to injectable fillers, which are injected under the acne scars and fill them up, leading to a smoother skin surface. Injectable fillers can be temporary or permanent.

3. Pulsed Light Treatment

Pulsed light treatments are non invasive light treatments that work best for brown and red acne scars. Most people need more than one treatment session. Although treatments are simple, they usually make the scars redder or browner for the first few days after the treatment. Costs vary from about $350-$635 per session. You may be able to claim some money back from Medicare.

4. Photodynamic therapy

Photodynamic therapy is one of the newer and very popular treatments for acne and acne scarring. During treatment a special cream is applied to the skin followed by exposure to blue or red light. The light activates the cream, which in turn attacks the bacteria which are present in the acne spots. The treatment is simple, not usually painful and is repeated about once per month. Most people are red for about 48 hours after the treatment. The treatment is safe, but it is important to protect from sunlight for 48 hours after treatment. The cost of treatment is about $450, but some money may be claimed back from Medicare.

5. Creams

Some creams e.g. vitamin A creams and glycolic acid gels can also help mild acne scarring.

How good is Fraxel for Stretch Marks?

Fraxel can produce about 30-40% improvement in stretch marks, but needs at least about 4-5 treatment sessions.

How useful is Fraxel for wrinkles and pigmentation?

Fraxel improves skin texture. It help wrinkles to some extent, but the results are not dramatic. It does produce good results for wrinkles on the neck and chest, and is far safer than other treatments for these areas.

Fraxel improves brown marks, but other treatments eg Pulsed Light and Q YAG often produce better results with fewer treatment sessions.