Many patients suffer from acne over the course of their lifetime. Unfortunately, acne and acne breakouts, if not taken care of promptly, can result in acne scars. Dr. Michele Green is a specialist in acne, skin discoloration and dark spots from acne, skin care, and the best acne scar treatment in NYC, in her boutique private Manhattan office. It is important to understand the fundamentals of acne and acne breakouts to best treat and prevent acne scarring.
Dr. Green offers extensive experience in the diagnosis and treatment of acne in order to prevent the evolution of acne scars, hyperpigmentation and dark marks. Dr. Green provides effective acne management, and the best acne scar treatment to reverse the effects of past acne scars and discoloration. With an extensive array of acne scar laser treatments and dermal fillers to produce new collagen, and replace lost volume, all types of acne scars can be treated safely and effectively.
Woman treated with acne scar treatment, vbeam and ematrix, 5 treatments
When the sebaceous glands function properly, they collect and excrete an oily substance called sebum, which helps to keep the skin healthy and prevent it from drying out. However, the very narrow channels through which the sebum leaves the sebaceous glands often become plugged. Acne is caused by this clogging of the pores and inflammation of the sebaceous glands.
Once these channels are blocked, bacteria that normally live within the sebaceous glands multiply rapidly, initiating the chemical reaction we know as inflammation in the skin cells. This in turn leads to the pimples, pustules, and cysts, associated with inflammatory acne.
Depending on the type of acne which each patient is suffering from, the goal is to cure existing breakouts and treat these flareups with either topical medications, oral medications, acne extractions, facials, hydrafacials, chemical peels, Blu-light therapy, or other in-office procedures at Dr. Green’s private NYC office.
What are the different types of acne?
- Blackheads – appear as black dots on the surface of the skin. They are also called open comedones because the head of the pore is open and the rest of the pore is clogged.
- Whiteheads – are also called closed comedones, which occurs when your pores get clogged from oil, bacteria, and excess sebum production.
- Papules – are small red bumps that appear on the skin, which are due to clogged pores, mixed with bacteria, such as P. acnes. Papules are generally free of pus as the bacteria has escaped through the open pore.
- Pustules -are generally inflamed and infected due to bacteria increasing in the blocked pore. The contents of these pustules contain pus, which is infectious in nature.
- Nodules and Cysts -are flesh-colored bumps that are below the surface of the skin and contain deep infections, which are laden with bacteria, and are generally very painful.
Topical acne treatment
There are several approaches which can be very helpful for controlling active acne, for preventing acne flare-ups, and improving skin tone and texture. Topical medications represent the first line of acne treatment currently utilized. Commonly used topical medications include the following:
- Topical antibiotics such as erythromycin, clindamycin, and sodium sulfacetamide to reduce surface bacteria.
- Benzoyl peroxide to reduce the bacteria living on the skin’s surface.
- Retinoids such as Retin-A, Retinol, and Tazorac which unplug the pores, gently exfoliate the skin, reduce inflammation, and increase cellular turnover.
- Azelaic acid to soothe inflammation, provide an anti-inflammatory effect, and reduce surface bacteria.
It is very important that patients follow their topical skin care treatment plan carefully, as the ultimate amount of improvement obtained depends at least in part on how well patients take care of their skin at home.
Oral medications are often used in combination with topical medications to treat existing acne and prevent new acne breakouts. Dr. Green may prescribe the following oral medications:
- Antibiotics such as Minocycline, Tetracycline, Doxycycline, and Oracea, to control the growth of bacteria in the skin and in the sebaceous glands.
- Birth control pills or Spironolactone (aldactone) to control the hormonal aspect of acne (in women).
- Accutane, as a last resort, to control acne that has been resistant to improvement through any other oral, topical, mechanical, or laser treatments.
23 year old woman treated for acne with accutane – 3 months
Extractions and Injections
Extraction of acne lesions refers to the drainage of pus, oil, and bacteria from acne lesions. Removal of these substances relieves any pain and pressure that may be present, shortens the healing time, and reduces the risk of acne scarring. Extraction of an acne lesion is often followed by injection of cortisone into the acne lesion to hasten healing.
Acne cysts heal quickly after they are injected with a diluted amount of steroid directly into the cyst. When used in this manner, the steroid rapidly reduces the inflammation and redness in the lesion. Injection of a pimple with a diluted steroid is the ideal treatment when the skin absolutely and positively must look better within 24 hours. This treatment is one of the secrets behind celebrity skin care.
What is an acne scar?
An acne scar is the result of an inflamed acne breakout, when the affected area of the skin becomes engorged with excess oil, sebum, dead skin cells, and bacteria. As the the affected pore swells, the bacteria also increases, and causes damage to the skin tissue. A small area of damage causes a small scar but a deeper infection leads to a deep scar on your skin. Although your skin will try to repair itself, there are many times when the wound is too large, or your skin is too delicate. In these cases, there is not enough new collagen to repair the wound. The result of this lack of collagen is an atrophic, or depressed scar. The three main types of atrophic scars are boxcar scars, icepick scars, and rolling scars. There are a myriad of methods to help improve the appearance of these depressed scars and Dr. Green is an international expert in the field of acne scar treatment.
While some acne is the result of genetics or hormonal imbalances, careful skin care and treatment can avoid acne from progressing into acne scars. It is best not to delay treatment if you have acne breakouts, and never to squeeze or pick your skin, since this will increase your chances of acne scarring.
What is the best way to remove acne scars?
The best acne method of removing acne scars is often a combination of different treatments. The first determination, which is necessary to remove acne scars, is to identify the type of acne scar. Are your acne scars red, white, raised, or indented? If your acne scars are red, you would benefit from the Vbeam laser treatment to reduce the redness in the scar. If you scar is discolored or hyperpigmented, a series of chemical peels, Cosmelan, Vitamin C serum, and Hydroquinones, may be the best choice. It is vital to select the best treatment regime to treat these dark spots, which appear as acne scars, from previous acne breakouts. If you have ice pick scars, or rolling scars, you might need a combination of various treatments such as chemical peels, laser treatments , and dermal fillers such as Restylane and Juvederm, to give you the best acne scar treatment. If you have keloid or raised scars, you may need intralesional cortisone injections and laser treatments to reduce these acne scars. It is very important to consult an expert in all of these different types of acne scars for the best cosmetic results.
Chemical Peels for acne and acne scars
Chemical peels are an effective way to treat acne and acne scars. Chemical peels for acne work by removing the surface layers of the skin, helping to exfoliate the epidermis, and producing new skin during this healing process. When chemical peels are done for acne, they are generally relatively mild. Appropriate peeling agents for acne include 20-40% glycolic acid, 10-15% trichloroacetic acid (TCA), salicylic acid, lactic acid peels and alpha hydroxy acids peels.
Regardless of the peeling agent used, a chemical peel for acne will help clear acne blemishes, reduce fine lines and wrinkles, lighten brown spots which result from acne (as well as from the sun or melasma), and smooth and brighten the skin. This process is a great way to help remove dead skin cells, and reduce dark marks on the skin. Patients undergoing chemical peels for acne will generally need to repeat their treatment approximately every four to six weeks. Dr. Green combines chemical peels for discoloration, particularly from post-inflammatory hyperpigmentation (PIH), with various strengths or percent hydroquinones. Dr. Green compounds a range of hydroquinone products in her office, from two percent to 10 percent, for her patients. After an acne chemical peel, the skin may be minimally red and irritated, but the recovery from the peel is very rapid and should be complete within a few days. Ultimately, both acne and acne scars will heal as new cell turnover is achieved. Lighter skin types are able to tolerate higher strength chemical peels that those with darker skin tones.
Chemical peels can be used on all types of scars. It can be used on atrophic scars such as ice pick scars, and rolling scars. Ice pick scars are best treated with a chemical peel process called TCA Cross. A strong strength of TCA is used, from 30 to 100 percent, and applied directly with a fine needle into each individual acne scar. This method of chemical peels is best reserved for patients with light skin tones. Patients of dark skin tone could potentially be hyperpigmented or have a loss of pigment, hypopigmented, from such a strong strength of acid. Patients with darker skin tones are best to avoid such high strength chemical peels and use the proper lasers or other modalities to treat their acne scarring.
Facials to treat acne and acne scars
Dr. Green also performs acne facials with great success on patients and recommends her at-home regime from MGSKINLabs, Inc. to complement these facials. The facial begins with a surface cleansing of the skin and a light microdermabrasion or glycolic acid treatment. This is followed by treatment with steam and extraction of any pimples. Then, a soothing and purifying mask is applied to the face. The final step in the facial is the application of oxygen. The acne facial improves acne, lightens any dark spots and blemishes, and leaves the skin glowing. This facial should be repeated at monthly intervals until the skin is clear, and should be thought of as an integral component of the acne at-home skin care program. Acne facials combined with your at-home skin care, will prevent future acne breakouts and acne scarring.
Hydrafacials are a medical grade facial in NYC, which helps treat superficial acne and acne scars. The skin is cleansed with the Active-4 cleanser, which is gentle and effective for all skin types. The cleanser softens sebum and dislodges dead skin cells. The next step in the Hydrafacial is an acid peel, the strength of which will be chosen by Dr. Green. We use salicylic acid and glycolic acid, during acne facial to help clean the residual acne. The next step is extraction using vortex technology to tighten pores and clear congestion. Lastly, your skin is hydrated with essential antioxidants, moisturizers, and vitamins to leave you refreshed and glowing.
Platelet Rich Plasma (PRP) with microneedling for acne scars
Microneedling with PRP, or collagen induction therapy, uses short needles which are inserted into the skin, to rejuvenate the skin and improve the appearance of acne scars. There is an immediate swelling and inflammation of the skin right after the microneedling, which makes you look better after just one treatment. Over time, these needles induce microscopic wounds in the skin which produce new collagen, improve both the tone and texture of the skin, and improve the appearance of your acne scars. One study showed that only 4 microneedling treatments, spaced one month apart, increased the collagen and elastin produced by your skin 400 percent six months after completing the course of treatment. Whether the microneedling is performed with the Dermapen, derma roller, or the Elite micropen, they each produce new collagen formation through collagen induction therapy and create younger-looking, healthy skin. Augmenting the results of microneedling with Platelet Rich Plasma (PRP), allows the natural growth factors present in your blood, to help repair and restore your skin.
Best Laser Acne Treatments
Vbeam laser treatment
The Vbeam® Laser is the gold standard in laser treatment to remove red spots and red acne scars. In general, a series of five Vbeam® laser treatments are given at 4-week intervals. Following a series of Vbeam laser treatments, inflammatory acne lesions are reduced by an average of 85% and non-inflammatory acne lesions are reduced by approximately 70%. In addition to treating acne breakouts, the Vbeam will reduce the redness in your acne scars, and general facial redness and rosacea in the skin. The Vbeam is a very gentle laser and can be used on patients with sensitive skin. Since many scars heal red, the Vbeam is able to eliminate this redness and restore a clear and luminous complexion to your skin.
Fraxel laser treatment / laser resurfacing
For acne scarring, the Fraxel laser is the gold standard for non-ablative laser resurfacing. With the Fraxel® laser, acne scars are improved over a series of 5 or 6 sessions. The Fraxel® laser utilizes fractional resurfacing technology, in which only a portion of the skin actually receives the laser light. With this technology, the laser delivers a series of closely spaced microscopic laser spots to the skin while simultaneously preserving normal healthy skin between the laser spots. This preservation of healthy skin results in rapid healing following the laser treatment. The entire face can be treated with the laser in approximately 15 minutes, and there is very little downtime following the procedure. Fraxel laser can be used on all different types of atrophic, or depressed scars to rejuvenate and heal your skin.
eMatrix laser treatment
The eMatrix laser is an extremely popular option for acne scar treatment. The eMatrix laser works via radiofreqeuncy technology and is an ideal treatment for all skin types. Since the eMatrix laser is “color blind”, it can be used for Asian, Hispanic, and African American skin. The treatments work by increasing collagen production and producing new healthy skin cells. This skin resurfacing laser, produces new skin by stimulating new collagen and elastin. Even after one treatment, your skin will be smoother. Over time, when new collagen is formed, the laser treatment will produce long lasting results. Dr. Green recommends five eMatrix laser treatments, for atrophic scars, spaced 4 to 6 weeks apart, for the best cosmetic results. The healing process generally takes 48 hours with almost no side effects except some minimal peeling, and redness.
eMatrix for acne scars, 1 treatment
Blu-U Photodynamic Therapy for acne and acne scars
For those patients who cannot tolerate oral medications to treat their acne and scars, BLU-U photodynamic therapy is effective for treating your acne and reducing the appearance of acne scars. The BLU-U Light kills the bacteria which cause acne breakouts, and treatments take only 15 minutes once or twice a week. PDT, or photodynamic therapy, works by reducing the oil glands on the skin, which in turn decreases the bacteria, and reduces the amount of acne. Photodynamic therapy can be combined with the Vbeam or IPL lasers, to best treat your acne scars.
How do Dermal Fillers treat acne scars?
Atrophic, depressed scars, like rolling scars and boxcar scars, can be quite deep. In order to help repair these deep scars, Dr. Green is an expert in replacing the lost collagen in these atrophic scars with an array of dermal fillers. The art of restoring the balance to your face, and improving the appearance of your scars, is selecting the right combination of dermal fillers for cosmetic injection. The most popular dermal fillers for the past ten years are formulated from hyaluronic acid. For deeper scarring, dermal fillers such as Restylane®, Restylane Lyft (Perlane®), Juvederm® or Juvederm Voluma may be injected below the surface of the skin to restore lost facial volume.
Depending on the nature of the acne scarring, Dr. Green may choose to inject Sculptra to help your body produce its own collagen. Through a series of injections with Sculptra, this liquid injection will replace lost collagen and naturally restore the balance of your face. Over time, Sculptra will induce new collagen formation and renew and repair the balance to your face from the acne scarring.
Bellafill was FDA approved in 2015 as an alternative to treat moderate to deep acne scars and nasolabial folds. Bellafill injections can last up to five years in duration and for this reason it is a popular alternative in certain patients with acne scars. Bellafill injectable fillers are composed of a collagen base and polymethyl methacrylate (PMMA) microspheres. Since Bellafill has a bovine collagen base, it is important to skin test all patients to Bellafill, before cosmetic injection; a subset of patients will be allergic to Bellafill. When Bellafill is injected into your acne scars, the body absorbs the collagen, and the PMMA microspheres stay in place in the skin. The PMMA acts to maintain long lasting support, up to five years, after the collagen is absorbed. This long term treatment for acne scars is why Bellafill is appealing to a subset of patients with deep scars.
Does Subcision work for acne scars?
Subcision is a unique treatment which helps improve depressed acne scars such as rolling scars and boxcar scars. Subcision for acne scars involves using a sharp instrument or a needle to “subcise” and help break up scar tissue from the surface of the skin. By breaking apart this scar tissue, which is tethered to the dermis, the epidermis, or top layer of skin is able to heal and produce new collagen. Dr. Green performs subcision at the same time that she is injecting acne scars with a dermal filler. By first using subcision, and then filling the space with a dermal filler, such as Juvederm or Restylane, the hyaluronic acid fills in the area which is depleted of collagen, until your body can produce its own natural collagen. This subcision technique is extremely effective since you have the immediate benefit of restoring volume into these scars via the injectable filler, and the long term effect of producing new collagen and elastin and rejuvenating your skin.
Which skin care is best to maintain healthy skin?
Patients always ask Dr. Green what is the best way to maintain healthy skin and minimize acne and the potential to have acne scarring. Dr. Green often prescribes Retinols, Retinoids, and alpha hydroxy acids, as these compounds increase skin cell turnover and new collagen formation. Her Essential Antioxidant Infusion is replete with Vitamin-A based Retinol and other essential skin vitamins. Retinoids reduce fine lines and wrinkles, increase new collagen production, and encourage neovascularization of the skin. Dr. Green recommends using a Retinol at night and combining it with a topical Vitamin C serum during the day, like Dr. Green’s most popular Vita-C-Serum in her MGSKINLABS, Inc. line of products. Skinceuticals’s Vitamin C serum with Ferulic acid is also quite popular. When choosing over-the-counter skin care at Sephora or Ulta, it is important to look at the ingredients in the products which you are purchasing, especially if you have acne prone skin.
When choosing products for acne prone skin, a cleanser with a salicylic acid base is generally recommended since salicylic acid is a powerful acne fighting ingredient. Salicylic acid can be incorporated into face washes as in Dr. Green’s Pore Minimizer Cleanser for acne prone skin, or into peel pad treatments, like Dr. Green’s Retexturizing pads. These Salicylic acid based products decrease pore size, exfoliate the skin, unclogs your pores, and with its anti-inflammatory properties, leaves your skin clear and visibly refreshed. When patients have an occasional acne breakout, it is important to have an acne spot treatment on hand to dry out that new pimple overnight. Dr. Green’s Acne Spot Treatment has Benzoyl Peroxide as its active ingredient to dry out that new blemish, making it disappear faster, either overnight or during the day.
Moisturizing acne prone skin is also extremely important since many topical acne treatments can be drying. It is important to choose an oil free moisturizer, which is non-comedogenic, and will not clog your pores. Dr. Green’s Ultimately Sheer Moisturizer is designed with oil-blotting technology, so while it moisturizes the skin, it will also remove the oily areas from your skin and does not leave it shiny like so many moisturizers can. When choosing a moisturizer it is very important to choose one that has been tested not to cause more acne, and states that it is non-comedogenic. Another important ingredient in a moisturizer is one that contains hyaluronic acid, as this ingredient provides excellent hydration, reduces the visible signs of fine lines and wrinkles, and speeds up wound healing. Dr. Green’s Hydra Repair is the number one hyaluronic acid serum used by the patients in her office.
Acne, acne scars and emotional health
Many patients feel depressed, anxious, and are self-conscious from their acne or resulting acne scars. Acne is an entirely treatable condition and there is no reason to suffer and not consult a specialist to help receive the correct treatment. The longer you suffer with acne, without the correct treatment, the greater the chance of acne scarring, and the more emotional distress it can cause. Dr. Green has cured every type of acne and she likes to say “there is no permanent acne!” We urge you to consult an expert, like Dr. Michele Green, to ascertain the etiology of your acne, provide the best treatment plan, reduce the appearance of your acne scars, and give you back beautiful clear skin.
How much does acne scar treatments cost?
Acne scar treatment is a cosmetic procedure and not covered by health insurance. The cost of acne scar treatments depends on the modality of treatment used and whether a board certified plastic surgeon or dermatologist versus an aesthetician is performing your treatments. The cost for a Hydrafacial will be much less than an ablative laser resurfacing procedure. In addition, each hyaluronic acid dermal filler is priced differently and it depends on how much volume and the number of syringes needed, to correct your scars and restore your facial volume. It is very important to google your treating physician and make sure that they have the expertise and experience in treating acne scars to have the best cosmetic results.
If you’re frustrated with the appearance of your acne or acne scars, there’s finally a solution that can help. Find out more and contact Dr. Green online or via this form below, or call 212-535-3088 to learn more about whether our combination approach toward acne treatment may be the best option for you.