Acne scarring is my specialty. My method of acne scar revision is aimed at treating each and every scar with the optimal treatment for that scar. Meticulous planning and mapping, together with angled photography provides me a treatment plan for your scars. I use a variety of lasers, chemical peels, fillers, surgical procedures and the very latest in technology and techniques to deliver the results in the before and afters gallery.
- Acne scars, no matter how old or severe can be improved
- 3 factors determine the ideal type of treatment- skin type, acne scar type and also the downtime
- Acne scar revision is my sub-specialty interest accounting for more than 60% of my work
- Each patient will receive a minimum percentage of improvement with an individually prescribed program
- I use techniques such as CO2 Fractional laser, Fraxel laser, TCA CROSS, and chemical peels, fillers ,RadioFrequency and surgery to treat your scars
- Each type of scar will have an optimal treatment
- Matching scar types and skin types to scar treatment procedures is the key to success
- On average, 70-80% of acne scars can be improved with a scar revision program
- Each program takes between 2-14 months to complete, depending on the severity of acne scars and your skin type
On average, patients will receive at least 70% improvement with a scar management program. Some patients with predominantly ice-pick and box car scars can expect up to 95% improvement, some patients with extremely severe scars with poor collagen can only expect a 50% improvement. Results are dependent on your scar type, and your immune factors on how well you can repair altered collagen within your acne scars.
My method of scar revision is based solely on finding the optimal treatment for each scar. I photography and manually map each scar type, and overlay photographs over a treatment map. This ensures that each scar will be treated with the best method.
Most patients will have mixed scars, namely rolling scars, box scars, ice-pick and anchored scars. This means that multiple modalities are needed. I then formulate a treatment plan over a period of 4-8 months to achieve the desired result.
Each type of acne scar will have a best form of treatment associated with it. Our technique matches the treatment to the scar type.
There are many factors that will determine how successful your treat is, however two main factors play a important part in predicting outcomes. Firstly the type of acne scars you exhibit, and secondly your skin type or skin colour. Most patients will have a mixture of acne scars, and hence different methods are needed to correct these scars. Patients with shallow box car scars in light skin type may only need one or two treatments, whilst darker skin patients with mixed scars may require many sessions over a year. Acne scarring is as unique as you are. Mapping photos are taken before, and after treatment. I undertake acne scar revision in patients who have realistic expectations and goals- namely my aim is to achieve scar improvement and not perfection in every case.
In some patients, psychological factors play a huge role in the perception of acne scarring. In this case I work in with a psychologist to help you through the difficult times. This gives the best outcomes.
I always choose a laser or medical equipment based upon the scar type, skin type and downtime of the patient. Lasers I regularly use include-
- Fraxel laser- this is a good all round laser for the treatment of most scars in all skin types
- Erbium Sciton Profractional laser- this laser is excellent as both an ablative as well as a fractional laser. It is especially good for Ethnic skin and deep rolling and atrophic scars.
- Erbium Fully ablative laser
- CO2 CORE Fractional laser
- CO2 fully ablative laser
- YOULASER- due in early 2017, this laser is twice as powerful as the Fraxel and CO2 combined
- V Beam vascular laser
- RF eMatrix RadioFrequency
- RF needling ePrime -Profound (outdated)
- INFINI RF insulated micro needling- this is my favoured device for severe rolling and atrophic scars
- Combination lasers and radio frequency -PRP. I frequently combine laser, energy devices and PRP in the one procedure.
Fractional lasers include CO2, Profractional, Picosure Focus and Fraxel. They all work by treating ‘fractions of the skin’s surface’ using columns of laser, depending on the wavelength. The ‘fractions’, power and depth can all be controlled by a Specialist to deliver optimal results with minimal downtimes. Acne scar treatments using fractional technology is over a decade old, however it is the choice of the correct fractional device that will give the best results.
More on Fractional lasers for acne scars
No. The ideal treatment depends on many factors including the type of scars, your skin type (ethnic origin) and your downtime. Fractional laser are best for certain acne scar types including rolling and mixed scars. Over the past few months I have been using insulated RF micro needling using the INFINI RF system plus PRP for severe acne scars. The best results are seen with combination treatments, including lasers, insulated RF micro needling and PRP. In march 2017 I have started using the YouLaser. This high tech laser is the absolute latest in fractional laser systems delivering both wavelengths of Fraxel laser within a millisecond of each other. Adjusting the pulse duration of this laser makes it 20-40 times more power than older fractional systems. My final conclusion will be out by August of this year. I have treated 22 patients in 111 days with this laser and it looks promising.
More on Fractional lasers for acne scars
Fillers are excellent for the treatment of atrophic and depressed acne scars. The advantage of fillers in the field of acne scar treatments is that results are instant and downtime zero. Some patients will require 2-4 treatments for best results, other patients will require only one session. In some cases, the improvement will be 100%, in others, 50-80%. It depends on many factors including the depth, location of the scars, and whether depressed scars are tethered to underlying structures. I often subscise the scar when I perform fillers. My technique of filling acne scars can –
1. Release the bonds that hold down the scar (tethered scars). This is because I subscise before I inject the filler
2. Stimulate new collagen formation. Fillers itself may stimulate collagen, but the trauma of micro needling during the procedure (see my video on how I perform this during the filling process) can also stimulate your immune system to produce new collagen.
3. Fill up the void of atrophic and tethered scars with fillers and HA. The results are instant and long lasting.
Acne scar treatments with skin needling
Skin needling and micro needling can be useful for mild and early acne scars, and can be safely performed at home. As a Specialist, I tend to get the more severe spectrum of acne scars, or scars that just do not respond to needling.
My approach to scar revision is unique, as I find the best method, rather than a device for your scars. Lasers provide much better acne scar remodeling than skin rollers. Skin needling is an entry level treatment for acne scars and gives only modest improvements for mild scars. Micro needling however is completely different. I use a special system that incorporated insulated micro needling with radio frequency. It is the delivery system of INFINI RF that makes this treatment unique. Insulation is the key, as it allows me to deliver the energy deep into the skin where acne scars lie. This is why this system is far, far superior than other RF micro needling systems. I often combine this with PRP. For atrophic scars, I combine subscision and fillers to achieve the results that you can see in my before and after pictures.
Acne scarring treatments
Surgery has a defined role in the treatment of acne scars this includes-
- Punch excision for very deep acne scars
- Subcision for tethered and anchored scars (video below)
- Excision for linear scars and bridging scars
TCA CROSS stands for TriChloroAcetic Acid Chemical Reconstitution of Skin Scars. This technique was invented over a decade ago and still remains as one of the best methods to treat deep acne ice-pick scars, box car scars and enlarged skin pores. Most patients will require 2-4 treatments for best outcomes.
Acne scar treatments with TCA CROSS is to treat the deepest scars first. This raises the scars to the same height. Once this is achieved, I often use a laser to remove the majority of scars. Remember, for acne scar revision always treat from the deepest to the shallowest scars. Sometimes I combine TCA CROSS with fractional devices, including fractional CO2 and erbium lasers in the one session. Every acne scar patient is unique, as are my combinations of scar revision programs.
This video shows how I perform the TCA CROSS procedure using my technique of osmosis with the needle. Note- TCA is not injected but ‘carried’ into the deep scars.
More on TCA CROSS
Radiofrequency or RF is an excellent treatment for early acne scars, and scarring associated with active acne. The Acne Free RF program treats both acne and scarring at the same time.
RF can also improve established old acne scars, including rolling, box-car scars and atrophic scars. For early acne scars (less than 3 months old, or red scars with slight depressions), I prefer to use the eMatrix RF system as this can give excellent results with minimal downtime.
Can I undertake scar treatments if I still have acne?
Yes, in fact this is the best time to undertake scar revision. Early acne scars remodel better than old acne scars. The Acne Free RF Program is designed to treat both acne and scars simultaneously. This uses RadioFrequency.
In 2015 I started the Acne Scar FOCUS program using the very latest Picosure Fractional laser. This laser is best for early rolling and atrophic acne scars, in ethnic skin types. Research to date shows that the eMatrix RF is superior to the Picosure Focus for early acne scars. I have also used the MAX RF system and this is inferior to the eMatrix RF- the power settings of MAX RF is simply not strong enough.
More on the Acne Free RF Program
Acne scar revision is a highly complex and individualized treatment. No two patients are the same, and hence pricing is extremely variable. As a guide-
- Fraxel or fractional laser resurfacing by nurse:-$990 (area dependent)
- TCA CROSS by Dr Davin Lim: $760-$890 out of pocket
- Filler- subcision by Dr Davin Lim: $760-$899 out of pocket
- Fully ablative combined with Fractional laser by Dr Lim: $1990-$4990 out of pocket
- INFINI RF performed by Dr Davin Lim – $1500-1900 out of pocket
- Surgical subscion and filler by Dr Davin Lim: $860-$1090 out of pocket
Medicare provides a partial rebate for scar revision on the face by a Specialist, however treatments such as Fraxel and Fractional resurfacing are NOT covered. Medicare threshold applies to most cases of scar revision. For severe cases of acne scars, up to 6-8 visits are required for best outcomes. For further information about the Medicare Threshold, call 07 3871 34 37 and speak to Miss Christa Bolton.
By Dr Davin Lim
Laser and Aesthetic Dermatologist
Acne scarring is one of the most common procedures I perform. Top level specialists will apply a method or technique to treat the individual scar, and not just rely on a machine to give a ‘generalized improvement.’ Most patients will have multiple scar types, including box car scars, ice pick scars, and rolling scars. Each subtype of scarring will have an optimal treatment. Not all scars respond to lasers- some scars such as ice pick scars respond nicely to TCA CROSS, whilst scars such as atrophic ones respond to filler.
An individually based method of acne scar treatments will give the best outcomes- assessing scar type, skin type and downtime gives the balance that is needed. Patients must have realistic expectations. In some patients 90-95% improvement is possible, however in difficult cases, only 30% improvement can be met. Everyone with acne scarring will present with unique scars in different locations.
I have a population biased when it comes to acne scars, as I get the most difficult scars to revise (many patients would have tried treatments by Cosmetic GPs, and beautician before seeing me). In this case, I liken acne scar revision to Orthodontic work- namely it takes many visits, often over a period of 6-8 months for me to revise scars. I employ many techniques to see how your scars respond to each. At the end of the program, individual scars can be targeted to get the best outcomes. I ensure that all my patients receive the absolute latest in laser and energy devices as well as acne scar revision techniques to achieve the best possible results. Scar are a reminder of the past, and can be markedly improved with time.