HOW TO TREAT ACNE SCARS | DOCTORLY

what's up everyone we're back dr maxfield dr shaw and welcome back to our channel dr lee where we talk about all things skincare and dermatology so today's topic is something that comes up a lot in the comments it's something we wanted to talk about for some time and now we're going to dedicate this space to acne scars acne scars so a lot of people suffer from acne and then after acne a lot of people develop scars and we're going to talk about all the different ways that you can treat them at home but unfortunately most of the treatments that are going to be really effective for those deep scars are going to require going to the dermatologist but we're going to go over all those different treatments and give you the best things that you can do for them we really want to include everything here because we want to equip you and let you know what's available so we want you to know what you're doing at home and if there's more that you can be doing even if you do have to go see a dermatologist for it before we get started the most important the very most important thing we have to say with this whole topic is that you have to treat your acne before you can actually treat the acne scars yes so if you're not treating your acne already then just skip this video all together because we've done a lot of videos on acne we'll link them above but it's critical to treat your acne first because acne from our perspective is way easier to treat than it is to treat acne scars once acne scars form they're very very difficult to get rid of so the most important thing you can get from this video is treat your acne first and then we'll talk about all the ways that you can treat the scars once they've developed so here's how to treat acne scars here we go here we go so when you hear the conversation of acne scars we think about really two main types you have the pigment changes after the inflammation and then you have true scars which are structural defects or changes after all this right so it's really critical to know what kind of acne scars you have because you can say acne scars and that's such a broad category you guys know how we're so deliberate at targeting different treatments towards a specific cause and so when you know what kind of acne scars you have then you can target your treatment to what's causing them and so with the pigment changes you have post-inflammatory erythema and that's red spots on the skin then you have post-inflammatory hyperpigmentation which is dark spots on the skin and then when we look at the ones that are actually true scars you can either have atrophic acne scars which are punched out areas of skin or you can have hypertrophic acne scars which are actually elevated parts of the skin and so once you put your scars into a category then you can tailor your skincare routine to target those scars so now we're going to go through each one of these and talk about what treatment is right for what type so the first one is the post-inflammatory erythema this is probably the most common i think that i see and it's also the one that's going to occur most immediately following acne after you've treated it so these are the little red spots that are on the skin after the acne bump is there after it goes away and they tend to get better on their own it can last for a few months but these are the treatments that will help knock it back quicker so the good news about post-inflammatory erythema is it does resolve on its own with no treatment as long as you're treating the underlying acne so this is the one where people come into our office all the time they have a bunch of red marks on their skin we look a little close make sure that there's no textural changes to the skin but as long as they're flat we tell them it's going to get better on its own so that's always good news to deliver to people there are a few things that you can do to sort of hasten the resolution i kind of made this new discovery in the last month we actually talked in a rosacea video about how green can actually balance out red because on the opposite sides of the color wheel so i found this product called the dr jart tiger grass camo drops what is this product well they contain chromium green oxides which balance out that red immediately so they're immediately gonna mask redness to the skin so anyone who has a baseline redness to the skin immediately obliterates it but it also has niacinamide and centella asiatica in it which treat underlying redness so because these resolve on their own if you just mask them and kind of help with some of the inflammation that's going on underneath the skin perfect so this is like the skincare hack if anyone is interested in trying to mask redness phenomenal product i love that you can mask it and treat it it's actually kind of a novel idea which is cheating it feels like like like it feels not right and then there's the other side of it we're going to talk about retinoids here because they do work for all of the types of acne scars that we'll be going through but you can use different which has adapalene in it and then laroche posse ethylclaraline it had pretty much the same product so these are going to be effective for this and again for every single thing moving forward yeah and adapylene is that main ingredient here it is a retinoid the thing is that it used to be a prescription and they actually made it available over the counter so very very effective a lot of studies behind it is going to treat acne and a lot of the scars that develop afterwards and that takes us to the next one which is post-inflammatory hyperpigmentation or the dark spots you get after acne and people with darker skin tones are more likely to get this i find that this lasts a little bit longer than the red spots i'd say like probably three to six months to a year for the dark spots to go away on their own right and this is one of those things that's extremely frustrating to people with deeper skin tones i'm somebody you're somebody who's sort of prone to hyperpigmentation that forms afterwards and so you have to relive the terror of your pimple uh for the next couple months and so there are a couple things that you can do to sort of hasten the resolution of them again these are not true acne scars and so they do often just get better with time to be honest but this is something because it lasts a little bit longer you may want to hasten the resolution so there's a couple thought processes here one you could try to speed up the cell turnover two you could try to exfoliate the skin that's actually going to help quite a bit as well and the third thing is you can actually go after the way that pigment is produced and so those are our theories on the way that we attack hyperpigmentation and we will do a whole video we promise it's such a difficult topic to go through but we will do a whole video on hyperpigmentation but we're just going to give you a couple of our favorite products that go after this problem and before we talk about treatments the most critical thing for this hyperpigmentation is going to be the use of sunscreen tinted sunscreens specifically with iron oxides are going to give you the best benefit to protect against hyperpigmentation yeah there are really so many ingredients that can work for this anything that treats hyperpigmentation or just pigmentation just like plug it insert it here and it probably is going to have some value these include retinoids tranexamic acid and niacinamide maybe even something like thiamidol which is a more novel ingredient vitamin c azelaic acid hydroquinone i mean there's just so many ingredients soy i mean there are so many ingredients that go after hyperpigmentation one of the things you should do is find a product that has multiple of these ingredients so they can work by different mechanisms so if you are somebody who has acne and is prone to hyperpigmentation there are two ingredients that i think rain king because they both treat the acne and the hyperpigmentation and so that's going to be your retinoids again and your azelaic acid and so if you're still having acne and you're trying to treat your dark spots these are the two ingredients i would focus on 100 agree i think these are the most effective um honorable mention niacinamide like if niacinamide was an entity it should be paying me royalty because it's just something i like a lot but nice and my honorable mention the max field niacinamide serum coming soon yeah all right but for real a real product you can use is going to be the polish choice discoloration repair serum this has a few nice things in it it has niacinamide just talked about that tranexamic acid i think there's a lot of evidence for this one and then it also has bokuchi all let's take a second just one second on boccuccio so there are a lot of retinoid alternatives and because has some of the better studies on it i actually think this is a promising ingredient it doesn't have like the century worth of experience we have with retinoids that we know it works but this one i like it's definitely one of the more promising ingredients i would like to see a little bit more studies on it but i think that of all the ones that have come out with a little bit of hype behind them it does have a lot of the most promising data on it and here's another product that's like basically a fire hose for hyperpigmentation it's called faded uh by a small company called topicals and listen to this ingredient list it's insane niacinamide tranexamic acid alpha butane azolic acid glutathione kojic acid i ran out of fingers here licorice root and turmeric so all of these ingredients have been shown to have benefit in hyperpigmentation now it is a strong product may cause irritation initially go slow with it but this has a lot of very promising ingredients in it and you probably will see some benefit to kind of hasten the resolution of that hyperpigmentation and then we'll transition out to hypopigmentation so these are just like light spots that occur after the acne bumps and what's happening here is the inflammation like consumes and damages the pigment making cells the melanocytes and they just get destroyed or they just become not functional and so these spots can be permanent they can fade over a long period of time like a year but they can be permanent and actually not a lot of treatments are going to help bring them back and there's one thing that you can kind of help to see if it's going to come back or not and if you have hair in this area so this is going to be maybe somebody who has you know maybe facial hair or something like this and you can see uh but if your hair has pigment in that area within the scar area or there's hair follicles nearby that have pigment then there's a better chance that you'll repigment this area because melanocytes from the hair follicle can travel and try to repair that area but once hypopigmentation forms it can be one of the most difficult things to treat you may actually need something called the melanocyte transfer which is a very very nuanced procedure that's done by plastic surgeons and so yeah so that's one of those ones that's very difficult so now we move out of the pigment part of this and we're going to talk about true acne scars so we have icepick boxcar rolling doesn't really matter actually because they're all atrophic or sunken in scars and then we have the hypertrophic scars but they're treated completely differently and that's why we make the distinction between the two so the atrophic acne scars like why do they even occur so we actually have this nice picture under the microscope this is what acne looks like and you can see that the inflammation is pretty deep so because this inflammation scarring can start at the deeper layers of the skin this forms a scar through and through the skin and it's just much more than just a surface problem right so some of these topical products that we you know we tout as you know the be all end all ingredients like retinoids they just don't get deep enough into the skin a lot of times to get after these deep acne scars which is why these atrophic acne scars are so difficult to treat and which is why unfortunately seeing a dermatologist is going to give you the best results for these acne scars that being said we're going to go over some of the treatment options that we have available to us as dermatologists and then at the end we'll give some over-the-counter product recommendations that will be beneficial for this type of scars so let's start off with micro needling what is microneedling so micro needling you hear about it all the time basically you poke little holes into the skin we use very sterile device clean head and you know we do this under sterile conditions where we are and poking little holes in the skin end up stimulating collagen production that can release those deep acne scars and kind of poof them up a little bit so that they can become level with the rest of the skin and the way that they sort of work is that they have anti-aging benefits they help with pigmentation they're safe for most skin tones which a lot of things are not necessarily scary for all skin tones like some lasers are not safe for all skin tones and so it's a really good starting procedure for someone trying to treat acne scars and we've talked about home microneedling and how that's beneficial in some situations but the downside especially here is the depth and thickness of the skin and then the depth of the scars so to get to the base of these scars and really stimulate that collagen growth at the bottom the needles have to be 1.5 to 2 millimeters long and that's just much bigger than what's available over the counter right and at home you don't want to really be poking that deep into the skin anyway so you know just be careful with some of these things that you know people are selling because you could end up worse off than when you started so that you know we always kind of exercise caution with this home micro needling devices so then we have this next treatment option this is just your chemical peels there's such a variable degree of these that can be effective and they all work in different ways so chemical peels are actually a pretty complicated topic and people have dedicated their whole careers to basically being the chemical peel person but basically we look at chemical peels by how deep they basically penetrate into the skin and how deep that exfoliating benefit is on the skin so you can have a superficial depth chemical peel you can have a medium depth chemical peel or you can have a deep depth of chemical peel and that's going to have different effects but if you think about it like dr maxfield was saying about the way that these acne scars form they are deeper down and so some of your stronger exfoliants are going to do much better than some of these superficial peels that you can find over the counter and so while the superficial peels kind of can even out that texture just by virtue of how you're using them they can even out the texture superficially then you need to get those deep peels and they actually use like pinpoint precision to selectively put it at the base of these acne scars to help regrow the collagen pretty much only where you want that damage and this is an example here of the tca cross procedure that uses trichloroacetic acid and that basically what it does is it really kind of causes that exfoliating benefit deep penetration into those atrophic or ice pick acne scars and can really really help to even out the skin texture it's also worth noting here that chemical peels like we said in our acne video has benefited treating acne and also has benefit in treating hyperpigmentation as well specifically you know salicylic acid and glycolic acid both do really really well for hyperpigmentation and salicylic acid is usually well tolerated by most skin tones and then i think stepping up from the chemical peels are going to be the laser treatment lasers overall are probably the most effective thing for treating most anything like whether it's anti-aging or here we're talking about scarring it's just extremely effective lasers have essentially replaced a lot of things we used to do in dermatology because they're so targeted and specific at issues you can take a specific wavelength of light and be like i just want to hit pigment i just want to hit redness i just want to hit collagen i just want to hit water you know so you can get very very very specific with lasers and you know the more specific we get the less damage we cause to surrounding tissue so laser is incredible for act these this type of acne scars so you're really going to want to talk to your dermatologist about this to find out what the best laser is going to be for this but you know erbium yag and co2 lasers that are ablative that truly ablate the skin those are going to be the most effective for trying to build collagen up and even out that skin texture but those are the ones where you're truly in my opinion you're going to see the most results with now the problem with lasers is that they're not safe for all skin tones and skin types and so you just want to make sure you have that conversation with your dermatologist and make sure that it's going to be appropriate for you yeah and there are non-ablative lasers they're actually some other things that we use to stimulate collagen growth under the skin so like you said we can selectively target things under in the skin without touching the top of the skin very much and so like an nd yag laser can use thermal license kind of activate some of that collagen or some of the fiberglass to try to induce growth without actually damaging the surface of the skin as well right and it's we kind of did a video on led masks and led masks do a very similar thing with the red light basically targeting fibroblasts through photobiomodulation to stimulate collagen production so that's also sort of another option that you could use here is much much less effective like they can't even quantify the difference between like a laser and an led but it would be helpful here the red light specifically there are a couple other procedures that are lesser used i suppose but also are very effective sometimes people do something called subcision where they cut underneath these atrophic acne scars and that sort of elevates the skin you can also do punch biopsies or punch holes in the skin that basically elevate these atrophic acne scars some people use filler dermal filler they can actually puff out these as well and you can also do something like dermabrasion where you basically sand the skin down to try to even out the skin texture so there's a lot of different options this is going to be something you really want to discuss with your dermatologist which is why we're so adamant about treating the underlying acne because as you can tell it gets much more complicated once these acne scars form so you know a couple over the counter options that can help are going to be your retinoids of course for the collagen growth and they do have a retinoid peel it's just at a much much stronger much stronger concentration than anything you're going to be able to get over the counter even generally with a prescription retinoids and chemical peels over the counter but like we said you know the peeling solution is not going to be as effective but if you really you know you don't have access to a dermatologist um and these procedures can be very expensive i would say that the ordinary peeling solution or the paula's choice peeling solution or a high strength exfoliant in general and a retinoid are going to be the two best options you have available to you at home but with the very very strong caveat but they're not going to be very effective and actually like a moment aside i think that's one of the most valuable things that like i think we want to impart is just setting realistic expectations because there's so many commercials or like tick-tock videos or they're like this healed my acne scar it is in fact hyaluronic acid or whatever it is like they're just setting you up for failure and disappointment like we just want you to know what's available and then also kind of give you like temporary expectations a little bit like it's going to work a little bit it's not going to cure it fix it perfectly right and you know i wish there was something right no i wish i wouldn't have to say go see a dermatologist well then i'd be unemployed but i also just wish that i could offer you something but they're really i mean we'd be doing a disservice if we said this was going to be the product you should buy yeah so now we move away from the atrophic and sunken in scars to the hypertrophic scars that have grown out and so while we were trying to build collagen now we're actually trying to get rid of the extra collagen or scar so this is basically you have a fibroblast in your skin your fibroblasts are little cells they produce collagen they produce too much collagen in this so you kind of have to calm them down a little bit now topical treatments at home really not going to have much effect on these these are a little bit less common but in the office what we do oftentimes is inject them with steroids to kind of calm those fibroblasts down yeah and the only one i think over the counter ingredient that you could really look for and use is going to be your silicone gel and like why this works still i'm not sure and again it's not perfect but the silicone gel they used to be silicone sheets and those are still available you actually will just occlude this scar area even if it's a mature scar that's been there a while and then you need to use it for at least two months to get benefit from it and then it can actually calm this down flatten it out soften it up a bit right so one of the products that's available you want to look for silicone-based scar gels things like mederma which have onion extract in them no benefit in the most recent studies that have come out the things that are going to be most effective were things like scar away stratiderm things that actually have silicone in them and silicones that do they think the hydration benefit is what does it but we don't really know like you said and then again for these you know we can use lasers for similar purpose just kind of a blade away that scar give it a chance to re-heal new and have a fresh start so that pretty much sums up the treatment for acne scars we'll leave some product recommendations below so that you can shop some of those hopefully you guys found this helpful yeah and again just cannot overstate like the most important thing please you know treat your acne if you've got to treat it before it scars you saw how difficult this was to like talk about how much goes into just removing a scar right we're here to help you you know dermatologists we are very very good at treating acne so please see a dermatologist if you have the type of acne that is forming those deep atrophic or hypertrophic acne scars if you are forming the redness or hyperpigmentation you can try to take care of this at home but like we said the deep deep scars are very very challenging to treat but thanks you all for tuning in we appreciate you very much always appreciate you guys please like comment subscribe we appreciate and love all the comments we do read that some of them are amazing they're hilarious and we read them and you know we chat about that yeah we sent them to each other so it really is a lot of fun for us so thank you all so much for all your support see you next time see ya here we go here we here we go [Music] [Music] maybe we should do like a venn diagram you know like uh the circles that's so good people aren't gonna care they don't care about our acne chart at all this is so good

Channel: Doctorly

Views: 1,330,544

Keywords: dermdoctor, dr muneeb shah, dr shah, doctorly, dermatologist, tiktok doctor, dr lj maxfield, skincare, dermatology, skincare routine, paula's choice, hyperpigmentation, dark spots, blemishes, acne scars, acne marks, red spots after acne, post inflammatory erythema, post inflammatory hyperpigmentation, rolling scars, ice pick scars, atrophic scars, hypertrophic acne scars, dr.jart+ tiger grass, camo drops, co2 laser

Id: Co4GTg3DT-Y

Length: 19min 54sec (1194 seconds)

Published: Fri Jul 09 2021