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Written for dermatologists by dermatologists. Indexed by the US National Library of Medicine.
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Acne Non-Surgical Treatment

There are several nonsurgical treatment options that may be appropriate for your acne scars, which include topical creams, chemical peels, skin fillers and skin camouflage.

1) Topical Creams: (Tretinoin)

Creams can act to improve your acne and help to smooth very fine acne scarring, these help by encouraging collagen production in your skin. They work in a similar way to the creams that improve the appearance of fine lines.

2) Chemical Peels: (AHA peels)

Chemical Peels can improve overall skin tone and lustre, but do little for scars, it works best if you get a series of at least six peels, having one every 1-2 weeks.

3) Skin Fillers:

Materials are injected into the depressed area of the scar to elevate it to the level of the normal surrounding skin. Results are temporary, lasting 3-6 months and are effective only in rolling scars. In Canada, Artecol®, which is a combination of collagen and methylmethacrylate, gives a prolonged benefit. However, the FDA in the US has not approved this to date.

Fibrel, collagen (Zyplast®, Zyderm®), Hyaluronic acid (Restylane®), and HylaForm® gel are used as dermal and subcutaneous fillers.

4) Skin Camouflage/Cover-up:

This may be the only option for some who cannot tolerate or cannot afford the other options.

5) Injectables: (Artecoll®)

This is a new injectable, long lasting skin implant for the correction of wrinkles and depressed skin such as scars. It is made of a combination of collagen and tiny spheres of a substance called polymethylmethacrylate, as well as the anesthetic lidocaine. These microspheres measure 32-40 micrometers, which are said to be too large to be removed from your skin by the macrophages in your body that normally remove foreign substances from your cells.

This substance appears inert in skin, and has been used for many years in dental prostheses, eyelenses, pacemakers, and for bone repair.

It is injected into the skin (collagen injection), then the body forms connective tissue in the form of collagen around the injected substance, which gives volume to the skin and corrects the wrinkle or depressed scar. This new tissue takes about 3 months to be completely formed. These spheres in a sense, form a skeleton around which new collagen is formed around the injected material.

There will be mild swelling initially, but this settles after a few weeks. Redness may also be seen for a few days, mild itching, and pain have been reported although it’s uncommon. These symptoms usually disappear after a few days, rarely about 1 in 800 have granulomas or lumps form around the injected material. This can be treated with a cortisone injection since Artecoll® correction lasts, it is important that not too much is injected into the skin at one time. Multiple small collagen injections may be the safest way of proceeding.

A skin test to the skin inside of the arm is always done with a small quantity of Artecoll® to ensure there is no allergic reaction to either the collagen or the lidocaine. You should not use Artecoll® if you have a reaction to the skin test or if you have a known allergy to lidocaine, collagen or cow products. Individuals who have thin, loose skin, or who make keloid, or thick scars, also should not use this product. It is prudent for those with immunologic diseases to avoid this procedure.

The most common defects for which Artecoll® is used are:

  • Folds and wrinkles of the face due to smoking, sun damage, and aging
  • Lip augmentation
  • Acne scars

Hyaluronic acid injection - Restylane®, Restylane Finelines®, Perlane®:

These are gels that are made of non-animal hyaluronic acid, which is a complex sugar derivative for injection into the skin. It is used to correct facial lines, wrinkles, folds, and for shaping facial contours, and may also be used for lip enhancement. Its use in acne scars may be limited. The benefits of these injections usually last for about 6 months.

There is some discomfort with these injections and reactions such as swelling, redness, pain and itching that may occur, but usually lasts for only a few days. There is a rare allergic reaction for 1 in 2000 patients where there is a more significant swelling and redness of the surrounding tissue. Skin testing prior to use is not usually done.