One of the most common questions asked in dermatology clinics is whether it is possible to remove acne scars and pigmentation. This is because a vast majority of teenagers and even adults experience acne concerns, and while the acne may resolve over time, it usually leaves scarring or pigmented marks behind, which can prove to be very tricky to remove. Out of the various methods of scars removal that are available to us, The Pico Laser Acne Scar Treatment has gained a lot of popularity lately and has been the topic of several recent studies.
Type Of Acne Scars
The acne scarring can be divided into two types based on the collagen loss or gain after the acne has resolved. While Atrophic Acne Scars are the more common type seen in 80 to 90% of individuals, a small minority also shows the other types of acne scarring known as Hypertrophic or keloid scars.
Atrophic Acne Scars
Atrophic Acne Scars are the predominant type of scarring that appears to be depressed. It is experienced by a majority of the people who suffer from an acne outbreak, particularly in the teenage years. These scars can be further be divided into three types based on their appearance. These subtypes include:
- Ice Pick: Ice pick scars are narrow and punctiform in appearance. Despite being smaller than 2 mm, these scars are deep, with their opening wider than their base. These represent 60 to 70% of all scarring. (1)
- Rolling: Rolling scars are caused by the tethering of the dermis of the skin to the subcutis layer. They appear to have sloping edges that extend to the base of the scar. These make up 15 to 25% of all scars.
- Boxcar: The Boxcar scars have well-defined vertical edges and a flat and wide base. These scars represent 20 to 30% of all scars.
Hypertrophic Acne Scars
Hypertrophic Scars are caused by the excess deposition of collagen around the acne site as it heals. Unlike Atrophic scars, which appear depressed, hypertrophic scars are raised scars and typically appear pink and firm.
Keloid Acne Scars
The Keloid Acne Scars appear as reddish-pink in color, and the nodules and papules formed are observed to grow beyond the original wound. (2)
What is the Pico Laser Acne Scar Treatment?
Picosecond pulse duration laser, commonly known as the pico lasers, has become an important tool in the field of dermatology. These were initially used for the purpose of tattoo removal; however, recent studies have shown them to be effective for acne scars and pigmentation disorders as well.
What Makes the Pico Laser Acne Scar Treatment Different?
The word Pico refers to the speed of the energy output of the laser used – which in this case, a picosecond is equivalent to one trillionth of a second. That is the speed it takes for each laser pulse to be delivered into the skin. Since the conventional laser system which was used previously was seen to operate to a billionth of a second or less, they are considered slower than the Pico laser. The disadvantage of slow lasers is that they lead to a longer contact time of the laser on the skin, which increases the chances of burns and other damages to the sensitive skin.
Pico Laser’s Effectiveness for Acne Scar Removal Singapore
What Types of Scars are treated with the Pico Laser?
Pico Laser is found to be the most effective for Atrophic and pigmented Scars due to its ability to correct the pigmentation and improve depressed skin texture efficiently. The effects of Pico Laser on atrophic scarring were further evaluated in a study conducted on patients who were treated with pico laser in 3 sessions. The results of the study showed that the Pico laser was effective in reducing the pigmentation, vacuolization, along with improvement of texture and collagen remodeling in atrophic scarring. (3)
How Does the Pico Laser Work?
Pico laser is seen to improve the acne scarring and associated pigmentation by increasing the density and length of the elastin fibers which are present in the affected dermis. These changes in elastin fibers at the occurrence of Elastogenesis, which lead to a reduction in scar depression. Studies have also shown Pico lasers to increase the levels of deposited mucin and collagen type three in the skin. This increase in collagen leads to effects of wound healing and reflects the presence of Neocollagenesis. (4)
Moreover, Pico Laser Acne Scar Treatment also has the ability to control the cavitation effect on skin layers without causing any damage to the treatment surface. Another benefit of Pico Laser over the other treatments like the Carbon dioxide laser is that it decreases the risk of post-inflammatory hyperpigmentation. As this is a conservative treatment approach, the skin surface being treated remains intact, and there are no open wounds after the completion of each session. This makes the healing time faster, which is estimated to lie within the range of 3 to 5 days.
The Effectiveness of Pico Laser Treatments
Pico Lasers are considered an effective tool for the treatment of depressed or pigmented facial acne scarring. However, numerous experts believe that it may be more effective for the treatment of different levels of skin pigmentation as compared to its effects on acne scars.
Many experts now believe that the Picosecond laser should only be used for mild to moderate acne scarring for those individuals who have undergone previously failed treatment options and require minimum downtime. Moreover, it is more appropriate to use Pico Laser as an adjunctive treatment method for acne scarring as compared to a solo treatment. (5)
Multi-Modality Approach for Treating Acne Scars
Usually, one experiences a few types of acne scars after recovering from an outbreak. Each type of scar response differently to treatments, and hence, it is common for doctors to recommend a mix of treatment options for treatment.
The Multi-modality approach for treating acne scars includes options like Chemical peeling, dermabrasion, non-ablative laser resurfacing, ablative laser resurfacing. If necessary, certain surgical options like punch excision and Subcision of the scars may be recommended. The multi-modality approach chosen for the treatment of acne scars depends on the type of scarring and the degree of scarring.
Other Acne Scar Removal Treatment Options Available in Singapore
The TCA peeling treatment involves the use of trichloroacetic acid in order to remove dead skin cells whilst stimulating the generation of new ones. This treatment is frequently used to attain younger-looking skin and getting rid of ice pick acne scarring and pigmentation.
Microdermabrasion is an exfoliation procedure that involves the usage of small crystals to remove the dead skin cells and reveal fresh skin underneath. It is found to be particularly helpful for evening out the skin around acne scars with slight depression. They can also help to flatten small bumps (hypertrophic scars) by gradually filing them down.
Dermal fillers are also used for the treatment of acne scarring. The most common fillers used are composed of Juvederm, Radiesse, and Restylane. The hyaluronic acid present in the fillers works by replacing the depressed areas by stimulating collagen production. This not only makes the scars less visible but also improves the skin texture.
CO2 Fractional Laser
Carbon dioxide fractional laser is a non-invasive treatment option for acne scars that uses a carbon dioxide laser to correct multiple skin irregularities. It achieves this by causing micro damages to the skin which helps to kick start collagen remodeling to rejuvenate the scared areas.
Subcision is a surgical alternative for acne scars and is considered a safe procedure that may be conducted in an office setting. This involves the use of a needle which helps separate the acne scar from tethering fibres beneath the skin, which allows new collagen to raise the depressed surface.
Dermal Grafting is most commonly used for the correction of acne scars that are round to oval in appearance. It involves the insertion of appropriately selected deep dermal grafts into the depressed areas of the atrophic scars to improve the overall appearance of the skin.
Risk And Side Effects Of Pico Laser Acne Scar Treatment
The side effects of Pico laser treatment are much less as compared to the traditional laser treatment due to the minimum amount of time that the laser heat is accumulated within the skin. However, those who experience side effects after treatment report the formation of pinkish spots or blisters on the face or the transient reddening and post-inflammatory hyperpigmentation of the treatment site. In order to achieve recovery, the patients are often advised to minimize sun exposure and keep their skin moisturized. (6) It is also important to find a doctor who is familiar with Pico Laser and its use for treating acne scars. That can help to reduce the risk associated with laser treatment.
Cost Of Pico Acne Scar Removal Treatments In Singapore
The price of the Pico laser acne scar treatment is often in the range of $300 to $500 in Singapore. However, the price of your treatment program may vary depending on the following factors:
- The severity of the acne scar
- Types of treatment required on top of pico laser treatment
- Suggested number of sessions
- Experience of the doctor and clinic reputation
Although Acne scars can prove to be quite frustrating for the individual affected by them, the right treatment modality at the right time can prove to be an efficient solution. Pico Laser System is one of the treatment options that is now gaining popularity for the treatment of such scarring; however, there is still a need for more research regarding the best treatment option that may be used.