Treatment of acne scars with dermal filler
By Dr. Ulrik Knap, Laser & Acne Scar Specialist
As a laser and acne scar specialist, I use different methods to treat acne scars, including dermal filler when I need to give more volume to the skin. Volumen loss is seen in atrophic acne scars which are caused by moderately to severe inflammatory acne.
My approach is unique in that way that I analyze each and every acne scar to identify the acne scar type. Thereafter, I match the best method with the acne scar type.
As a laser and acne scar specialist, I have years of experience treating patients with severe acne scarring. One of my treatments, which are often combined with other methods, is dermal fillers.
In this article, I’ll give you some insight about dermal fillers, when they can be used, which treatments dermal fillers can be combined with, the benefits of using dermal fillers and more.
But first, let’s take the basics…
What is dermal fillers and why do I use them?
Dermal fillers are gel-like substances that are injected beneath the skin to restore lost volume.
There are many different filler brands, including Restylane, Juvederm, Radiesse, Sculptra, and many more.
Dermal fillers can be characterized in a number of ways. However, to simplify it, there are basically two types of dermal fillers; HA fillers (or hyaluronic acid fillers) and other types of dermal fillers (non-HA fillers).
HA fillers are generally safer to use than non-HA fillers with fewer side effects.
However, the effect of HA fillers typically lasts shorter than non-HA fillers. Hence, there are both pros and cons.
Radiesse is a non-HA filler. It contains calcium hydroxyapatite and stimulates collagen. So not only does it fill, but it also stimulates at the same time.
Sculptra is another example of a non-HA filler. This is what we know as a poly-l-lactic acid, and again this filler is really good to stimulate collagen. This kind of filler is great when treating patients with a lot of fat atrophy.
I use dermal fillers to enhance my results when treating acne scarring.
Which acne scar types can be treated with dermal filler?
I use dermal fillers for boxcar scars, e.g. chickenpox scars, and large atrophic rolling scars.
When I perform subcision, I always inject a dermal filler beneath the acne scar to avoid the creation of new adherences which would ultimately cause the scar to tethered again. The dermal filler acts as a buffer beneath the acne scar. Besides, the dermal filler adds volume which is of certain importance in atrophic scars.
Can dermal fillers be combined with other methods?
Yes, absolutely. To achieve the highest cure rate, I always do my initial analysis of the patient’s acne scars to identify the correct acne scar type. Matching the acne scar type with the right method gives the best outcome. Most patients have a combination of different acne scar types. Therefore, performing acne scar revision often involves a variety of methods including TCA cross, dermal filling, subcision, punch excision and fractional laser resurfacing. All of these methods can be done in the same session or in several sessions of treatment depending on the patient’s preferences.
I often combine dermal fillers and subcision in the same procedure when treating tethered and anchored acne scars, e.g. in rolling scars.
When I perform subcision in areas of the face where the skin is very fine, such as in the temple, I use a thin needle, while in areas where the skin is thicker and fibrotic bands might be more severe, I use a Nokor needle to break down the fibrotic bands which pull down the scar. The result is seen immediately after the procedure.
To avoid new adherences being formed underneath the scar in the following months after subcision, I inject a dermal filler immediately after subcision. The dermal filler acts as a buffer beneath the acne scar and provides volume to the atrophic acne scar which gives an immediate result.
What are the benefits?
The benefit of dermal fillers is that the effect is immediate, and it prevents the acne scar to tethered again after having performed subcision to untether the scar.
Besides, dermal fillers stimulate new collagen production.
How long does it take to perform?
Injection of dermal filler is a relatively easy and safe procedure to perform. If I only have to treat a single atrophic acne scar with a dermal filler, it might take me some few minutes or less. Treating several acne scars with dermal filler together with subcision can last between 15-20 minutes depending on the number of tethered scars and the amount of fibrosis to be broken down.
How is the treatment performed?
When I treat atrophic acne scars with a dermal filler, my purpose is to add volume to the scar. When the procedure is done immediately after subcision of anchored or tethered acne scars, the filler acts as a buffer and prevents the scar to adhere to the underlying muscle fascia and fatty tissue.
Treatment with a dermal filler is performed by injecting the gel-like substance underneath the acne scar. This can be done either by using a sharp needle or a blunt cannula depending on the type of acne scar, location of the scars and the thickness of the skin scars.
When the procedure is performed following subcision, the area is always numbed with a local anesthetic to reduce any pain to zero.
How does the skin look like after the treatment?
The downtime after injecting a dermal filler is very short.
Bruising can occur. This is completely safe and nothing to worry about. The bruising typically disappear in a few days. Remember that you’re always allowed to use a recovery makeup (e.g. Lycogel) or similar products to cover any bruising after the procedure.
How many treatments are necessary?
This depends on the severity of the acne scar. When performing dermal filling and subcision, 1-4 treatments should be expected.
How long does the effect last?
Using a dermal filler, the effect typically lasts several years depending on the type of filler, the technique and whether the procedure is combined with other acne scar treatments.
The best thing about dermal filler is that it gives an immediate improvement of the treated acne scar, and stimulates the collagen formation in the skin.
Best Regards
Ulrik Knap, MD., Laser & Acne scar specialist
