What's the best way to get rid of acne scars?
Acne scars can be minimized using laser devices
Based on my experience, acne scars can be greatly minimized, but are
impossible to completely clear, even with deep laser peels. The
deeper the scar (like ice pick scars), the more difficult it is to
treat. Combination therapy seems to work best.
For mild acne scars, we tend use chemical peels, light erbium peels
or 1064 q switch laser treatments. It will often take a series of
these treatments to get optimal results.
It is important to make sure that active acne is treated, and
several of these treatments have the added advantage of helping to
reduce acne breakouts.
For moderate scars we use moderate depth erbium laser peels. It may
take 2-3 peels over 9-12 months for optimal results. Using various
parameters, we can resurface the scars and stimulate collagen, thus
filling the depressed defects.
Severe acne scars are treated with papillary dermal erbium peels.
These are rather deep peels, done in the office with both topical
anesthetic and selected nerve blocks on the face. Healing time is
7-10 days.
As always, with any of these treatments, a good retinol based skin
care regimen is required for long term maintenance.
What's the best way to get rid of melasma?
Treatment of melasma is always difficult
I have found, as have most physicians who treat melasma, that
nothing is a sure bet. We have used IPL, erbium lasers, q-switch
lasers, photodynamic therapy with levulon as well as multiple
topical preparations, all with limited success.
I have found that the most effective therapy has been with topicals,
such as Epiquin Micro by Skin Medica combined with the 1064 q-switch
laser. The 1064 q-switch is designed to treat dark dermal pigmented
lesions and as a result seems to lighten melasma. It takes multiple
treatments, but it does work. A maintenance program with high
quality cosmeceuticals including Epiquin Micro, a laser treatment
every 3-4 months, and most importantly, sun protection with both an
SPF and sunblock will give you a good chance at controlling your
melasma.
Good Luck!
Is BLU-U better than IPL for treating acne?
Blue light & red light combo is usually best
In our office, light treatment augments traditional treatment for
acne. For mild comodomal/pustular acne, we still use traditional
topical treatment. For more progressive inflammatory acne, we use
topical and light therapy. Cystic acne is often treated with oral
and topical medications along with light therapy. Light therapy
typically comes in two types:
▪410nm blue light
▪1064nm red light
Blue light initiates a chemical reaction that causes the
proliferation of endogenic porphrins (chemicals that you have within
the skin), which attack and kill p. acnes, the bacteria that is
responsible for acne. Since the reaction is not antibiotic-mediated,
one never develops a resistance to blue light therapy.
Red light, however, works on the sebaceous glands rather than the
bacteria that cause acne. The sebaceous glands produce sebum, which
flows out of the follicle to protect the skin. Bacteria tend to live
within the follicular-sebum mileu. 1064nm light can penetrate deeply
into the skin and destroy the sebaceous glands, thus decreasing
sebum production. The end result is less p. acnes and less acne.
IPL typically has wavelengths of 510-1200nm, thus theoretically
covering both the effects of blue and red light. Unfortunately, the
absorption spectrum of the porphyrins within the skin is pretty
specific. Blue light concentrates all its energy at 410nm, the ideal
wavelength, whereas IPL only has a small amount of energy within
this range. The same applies in the red light spectra. A 1064nm
laser emits concentrated energy in this spectra and has a better
effect on destroying sebaceous glands than IPL, which again devotes
less energy to this wavelength region.
In our office, we combine the use of blue light and 1064nm lasers to
both kill p. acnes and reduce sebum production. The result, I feel,
is better than IPL or either device alone.
- Stephen Nightingale, M.D.
