Acne Scar Laser Treatment & Removal
In London and Surrey
Dr Hussein is recognised as a national authority in the management of acne scar treatment. He teaches and lectures regularly on the subject. He specialises in the use of a technique called laser resurfacing for the improvement of acne scarring. Both fractional and fully ablative laser resurfacing are used in conjunction with the methods below to obtain the best possible improvements in acne scarring. This laser resurfacing is performed with surgical-grade CO2 and Erbium YAG lasers. Most clinics use low power CO2 and non-ablative lasers. These devices do not have the same capability as the lasers that Dr Hussein uses in his practice.
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- Potential Complications
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Dr Hussein’s pursuit of excellence and commitment to the state-of-the-art in cosmetic dermatology and laser surgery leads him to invest in only the best laser equipment to get the job done. The best equipment combined with his specialist knowledge in cutaneous laser surgery makes him one of the UK’s leading doctors in acne scar management.
Dr Hussein’s treatments constitute laser skin surgery. They are not aesthetic medical treatments performed by medispas or low level cosmetic medical practices. The treatment will give the highest degree of improvement in acne scarring but needs to be performed in a medically controlled environment under special types of local anaesthetic (potent topical anaesthetic gels or tumescent local anaesthesia). Undergoing this type of treatment usually requires in the region of 10days recovery time. Redness of the skin can continue for several weeks but this can be camouflaged with make-up.
He also uses multiple adjunctive techniques such as:
- Full Field Subcision (Taylor Liberator) of acne scars under local/tumescent anaesthesia
- Punch Excision of acne scars
- TCA CROSS (Chemical Reconstruction of Skin Scars)
There is a myriad of treatments that are available for the treatment of acne scarring but unfortunately, most of these are mild low-grade aesthetic/beauty therapy treatments. This section of Dr Hussein’s website is designed to give you specialist advice on the issue of acne scarring and help you to make an informed choice about treatment.
Not all laser is the same
One of the lasers that Dr Hussein uses is a Lumenis Ultrapulse CO2 laser. This is the same surgical CO2 laser used in the burns unit of the Chelsea & Westminister Hospital in London. It is also used in the St Johns Institute of Dermatology in London. There are around 5 of these devices located in NHS in the UK. They cost in the region of £100K. They are powerful precise surgical tools that have sufficient penetration depth and power to treat acne scarring in the most effective way.
Many clinics may advertise the use of CO2 laser but these devices are usually of relatively low power. Examples of these lower power devices are lasers such as Deka Smartxide, Candela CO2RE and Alma Pixel. These machines cost in the region of £30K and can only achieve a much milder result in the treatment of acne scarring. This is because of the devices low powered fractional only nature.
Whilst they may go some way to helping in the treatment of acne scarring they cannot deliver the type of results that Dr Hussein will achieve. This is because he uses advanced surgical grade lasers such as Lumenis Ultrapulse CO2 and Sciton Joule X Contour TRL Erbium YAG.
This is by far the most popular treatment used to treat acne scars. It is effective but only mildly so. Treatments are multiple in nature and do go some way to produce new collagen and remodel collagen in sunken acne scars. One of the reasons why this treatment is popular is because the recovery time is quick. Usually, the patient can go to work the next day with only some mild redness as a consequence. The redness usually will last a maximum of 2 days. Even though tangible benefits are only very mild in each treatment the trade-off is quick recovery. it is a good way of improving one’s acne scarring without having to take time off work. There are multiple devices. Dermapen is an electronic needle stamping device in which needles can be repeatedly stamped to a controlled depth (eg 1.5mm) at a speed of 100 times per second! Less state-of-the-art in the world of microneedling are simple roller devices that needle the skin using a rolling motion. Often local anaesthetic cream is used prior to the procedure as it is uncomfortable despite a quick recovery.
This is also a proven technique in the treatment of acne scars. A caustic agent such as Trichloracetic Acid (TCA) is applied to the skin and causes the outer layers of skin to be removed by a process of controlled chemical burn. This helps acne scarring in two ways. There is an element of surface remodelling through regrowth of a new superficial dermal and epidermal layer. The inflammatory process causes an increase in the production of new collagen as part of the healing process. By the nature of chemical peels, this remodelling and collagen formation is limited to the upper layers of the skin.
Improvement is mild but if a good medically qualified provider is used a typical TCA 25%/Jessners combination peel or TCA 35% peel can achieve a better result equivalent to multiple microneedling treatments.
The downside is that recovery time is in the region of 7-9 days. As a result, more technically advanced treatment providers are offering fractional laser resurfacing as the benefits are greater for a similar amount of downtime. Therefore chemical peels although effective are seen as somewhat old-fashioned.
This is a type of microneedling that combines radiofrequency energy via the needles. The idea behind this concept is that with the thermal energy created by radiofrequency greater collagen stimulation is created than needling alone. There is limited evidence to support this claim. At present results appear to be more device, technique and operator dependent. Fractional laser treatment with CO2 laser is a more powerful modality with a much larger evidence base.
Post Inflammatory Hyperpigmentation (skin darkening)
This is the most common side effect. It is most common on darker skin types. Thankfully it usually spontaneously improves. Improvement can be speeded up by the addition of topical treatment such as hydroquinone 4% cream. Duration usually depends on the severity of the inflammation that created it in the first place. Complete resolution can take anything from a few weeks to 6 months depending on severity. Sun exposure is the most common aggravating factor and this is why strict sun avoidance is important in the first few weeks following treatment.
Hypopigmentation (skin lightening)
True hypopigmentation is rare (<1%). More commonly patients may experience a lighter skin tone from newly formed skin. This is called pseudo-hyopigmentation. The cause of this is that new skin contains more highly organised collagen bundles that reflect more light giving an impression of lighter skin. There are also many sun damaged (perma-tanned) people who will notice that their new skin is lighter as well.
This can happen in any kind of laser resurfacing. Even non-ablative laser resurfacing. It is more likely to occur in fully ablative laser resurfacing. The likelihood is around 3% bacterial or fungal infection in the most aggressive laser resurfacing and 10% viral infection (HSV – cold sore virus). Uncontrolled infection can then go on to result in hypertrophic (raised bumps) scarring. Thankfully if treated early any problems can be prevented. This is why Dr Hussein monitors the healing with the use of ‘selfie’ photos every two days for the first week. Any problems can be detected early in this fashion and appropriate interventions can be made. It is normal practice in Dr Hussein’s more aggressive treatment cases to prescribe a prophylactic medication pack to be taken according to instructions. This further reduces the incidence of infection.
There are three causes of permanent scarring post laser resurfacing treatment. The first is uncontrolled infection. This is highly unlikely due to insistence by Dr Hussein on direct photo monitoring in the first week post treatment.
The second reason is due to a thermal injury directly created from the laser (burn). This is extremely unlikely due to Dr Hussein’s level of experience and expertise.
The final reason is a rare condition called erosive pustular dermatosis. This is an exceptionally rare condition in which the skin undergoes a prolonged delayed healing process after treatment. Nobody can predict this but a handful of cases worldwide have been encountered. Incidence is extremely rare and as a result difficult to accurately quantify.
Prolonged redness (erythema)
This is not really a complication but an expected effect of more aggressive laser resurfacing. It can be easily camouflaged with foundation and will always eventually settle. Men find the idea of make-up more difficult to handle. In general however men are less concerned than women about the redness. Duration varies from individual to individual but also correlates to the level of aggression of the laser treatment. More aggressive correlates with longer duration.
Post resurfacing contact dermatitis
This is a form of increased sensitivity of the skin that is encountered by a proportion of individuals post laser resurfacing. In some cases it can be quite severe. Mild irritants can trigger a disproportionately large irritation of the skin (burning and itching) that then can result in prolonged redness and darkening of the skin. It is usually treated by topical steroid ointment if it occurs and eventually spontaneously settles. Triggering can be minimised bu the use of mild perfume free cleansers and skin product post treatment. Dr Hussein can advise on these.
Isotretionoin (Roaccutane) & Laser resurfacing
This is a potent oral retinoid medication that is used to treat more severe cases of acne. It can potentially affect the healing response of the skin in more aggressive ablative laser treatments such as those that Dr Hussein performs. As a result Dr Hussein generally performs his more aggressive ablative laser resurfacing treatments at least 6 months after cessation of oral isotretinoin medication. There is growing evidence to suggest that waiting 6 months may be unnecessary. Retinoids will also increase the incidence of post resurfacing contact dermatitis and sensitivity. Dr Hussein firmly sticks by the 6 month rule.
- Surgical subcision under tumescent local anaesthetic – from £1,750
- Laser resurfacing CO2 full face (fractional or fully ablative or both including Erbium YAG laser if necessary) – from £3,750
- Fraxel laser single session – from £1,500
How does acne scarring occur?
Scarring can develop following acne, especially where nodules and cysts are a part of the disease. The inflammatory process in acne causes damage to the collagen scaffold of the skin resulting in pitted acne scars (atrophic scars). Very rarely in about 5% of cases acne results in overgrown raised scars (hypertrophic scars).
What will the treatment for acne scarring feel like?
For aggressive resurfacing with CO2 or Erbium YAG laser Dr Hussein uses a combination of nerve blocks, tumescent anaesthesia and sedation coupled with a topical anaesthetic prep. Basically everything short of putting you to sleep. Most areas of the face become completely numb but some areas on the cheek and nose tip may have a little bit of breakthrough pain. The advantage of doing fully ablative treatment under this type of anaesthetic is that you can go home (accompanied and NOT driving yourself) 30 mins after treatment. Putting you to sleep for this treatment which used to be the case doubles the cost as anaesthetist fees and overnight stay in a private hospital have to be factored in. After the laser procedure you will feel a sunburn sensation but this will completely settle after 24 hours. The main inconvenience for the first 3-4 days is ooze and swelling. Ibuprofen in the first 24hrs helps settle the burning sensation. By day 4 the oozing will have settled. What now follows is a shedding of the dead skin layers and this can be seen as fresh pink skin appearing. Sometimes people get itchy at this stage. This can be helped by an antihistamine and a special cream that Dr Hussein issues at the procedure. Dr Hussein will instruct on the use of the cream. By day 8 most of the dead skin has come away. You will now look red/pink. This redness will persist but slowly reduce over the next 6-8 weeks. Sometimes Dr Hussein can speed the resolving of the redness with KTP laser. Make-up and foundation can be commenced cautiously on Day 10 after treatment. Foundation and SPF or a BB cream disguise redness nicely. Dr Hussein can advise on appropriate skincare after treatment.
How long until my acne scars disappear?
During your initial consultation we will determine the exact type of scarring. Any underlying acne must be treated and settled before treatment. If you have been put on Roaccutane (isotretinoin tablets) then you will need to wait 6 months after you have completed treatment to have laser. In general acne scars will not disappear. Appearance will improve by 50-70% following fully ablative combined laser resurfacing. Images to show the degree of improvement are available in the gallery. In general, this full improvement can be observed at roughly 4 months after treatment.