Acne scars – treatment in Wrocław

Acne scars arise as a consequence of inflammation involving the dermis. It is estimated that permanent scarring develops in 30–40% of people who have had acne of moderate or severe intensity. The risk of scarring is greater the longer the inflammatory lesions persisted and the more often they were removed mechanically.

We plan the treatment of scars only once the inflammatory process has been brought under control. Carrying out procedures during active acne does not bring a lasting effect, because a further scar may arise at the site of every new inflammatory lesion. The most effective course remains early and consistent treatment of the acne itself.

We hold consultations and perform procedures in Wrocław at ul. Barlickiego 31/1U. Reception: 573 290 488.

Types of post-acne changes

Atrophic scars

They constitute the great majority of post-acne changes. They arise from a deficiency of collagen at the site of healing. In clinical practice three forms are distinguished, differing in shape, depth and susceptibility to the individual methods of treatment.

Type of scar	Characteristics	Methods with the greatest effectiveness
Narrow, deep scars (ice pick)	Diameter below 2 mm, steep walls, reaching deep into the dermis. The most difficult to treat.	Spot application of trichloroacetic acid, ablative fractional laser.
Boxcar scars	Diameter 1.5–4 mm, distinct, sharp edges, a flat floor.	Ablative fractional laser, microneedling, filling with hyaluronic acid.
Rolling scars	Wide depressions with gentle edges, arising from fibrous adhesions joining the skin to the subcutaneous tissue.	Release of the adhesions with a needle, fillers, fractional laser.

Hypertrophic scars and keloids

They arise from the excessive production of collagen and take the form of thickenings raised above the level of the skin. They occur more often on the trunk, the arms and the jawline. A keloid differs from a hypertrophic scar in that it extends beyond the borders of the original injury. Management covers above all intralesional injections and cryotherapy.

Post-inflammatory pigmentation and erythema

Brown patches and persistent redness at the site of resolved acne lesions are not scars, because they are not accompanied by a loss or an excess of tissue. These changes resolve spontaneously within 6–12 months, and appropriate management shortens that time. The distinction matters in practice, because the methods of treatment differ from those used for scars.

Qualification for a procedure

The first visit is a medical consultation. We assess the type and depth of the scars, the activity of the acne, the skin phototype and the tendency to post-inflammatory pigmentation. We also establish whether the patient has taken oral isotretinoin in the preceding months, because this affects the date on which procedures can begin.

Active inflammatory lesions – we postpone procedures on the scars until the acne is under control.
Oral isotretinoin – we plan ablative procedures after the interval, usually 6 months from the end of treatment, because of altered healing.
Skin phototype – in patients with a darker complexion we choose parameters that limit the risk of post-inflammatory pigmentation.
Sun exposure – we do not perform laser procedures on tanned skin; the treatment season begins in the autumn.

Methods used at the clinic

Ablative fractional Er:YAG 2940 nm laser

The basic method of treating atrophic scars. The laser beam creates microscopic columns of thermal damage in the skin, surrounded by intact tissue, which sets in motion the process of remodelling and the formation of new collagen. We perform the procedure under local anaesthesia in the form of a cream. The full effect of the remodelling of the skin develops over 3–6 months from the last procedure.

The recommended number of procedures is usually 3–5, every 4–6 weeks. The expected improvement in the appearance of the scars is described in the literature as partial; the complete removal of scars is not possible and we state the aim of treatment in those terms during qualification.

Microneedling of the skin

A method using controlled punctures of the epidermis and the dermis, leading to the stimulation of collagen production. Used alone or as a supplement to laser procedures, particularly in patients with a darker phototype, in whom the risk of pigmentation after a laser is greater.

Spot application of trichloroacetic acid

A technique intended for narrow, deep scars. The preparation in high concentration is applied only to the floor of the scar, which causes it to contract and become shallower. The procedure requires precision and is performed in a series of 2–4 repetitions.

Release of fibrous adhesions

A procedure intended for rolling scars. With a needle, the bands of connective tissue pulling the skin downwards are cut, which allows it to lift. The method is sometimes combined with the administration of a filler in the same procedure.

Hyaluronic acid fillers

They make it possible to raise single atrophic scars immediately. The effect is temporary and usually lasts 9–18 months depending on the preparation used.

Vascular laser

Used for persistent post-inflammatory erythema and for hypertrophic scars of a vivid red colour. The beam is absorbed by haemoglobin, which leads to the closure of the dilated vessels.

Management of keloids

The treatment of first choice remains intralesional injections of a glucocorticosteroid, performed every 4–6 weeks, sometimes in combination with cryotherapy. We do not use ablative procedures on keloids, because they may increase the growth of the scar tissue.

The course of a laser procedure

Preparation – cleansing of the skin and application of an anaesthetic cream 45–60 minutes before the procedure.
The procedure – it lasts 20–40 minutes depending on the size of the area. Patients describe the sensation as heat and pricking of moderate intensity.
Directly after the procedure – erythema and swelling persisting for 2–4 days, then fine peeling of the epidermis for a further 3–5 days.
Return to everyday activities – usually possible after 5–7 days, when the visible peeling subsides.

Recommendations after the procedure

use of the regenerating preparation indicated by the doctor for 7 days,
sun protection with a filter of at least SPF 50 for a minimum of 4 weeks,
no sauna, swimming pool or intensive physical exertion for 7 days,
no mechanical removal of the peeling epidermis, because this leads to pigmentation and may leave a new scar,
stopping preparations with retinoids and acids 7 days before the procedure and 14 days after it.

Contraindications

an active skin infection in the treatment area, including herpes,
pregnancy and breastfeeding,
a tan and sun exposure within the 4 weeks preceding the procedure,
a tendency to form keloids,
coagulation disorders and anticoagulant treatment,
diseases with photosensitivity,
an active neoplastic disease in the treatment area.

Results and the expected duration of treatment

The improvement in the appearance of atrophic scars after a full series of laser procedures is described in clinical studies as partial and depends on the type of scars. Rolling and boxcar scars respond to treatment better than narrow, deep ones. The effect is assessed no earlier than 6 months after the last procedure, because the remodelling of collagen proceeds gradually.

In most patients a smoothing of the surface of the skin and a reduction in the visibility of the depressions in side lighting are obtained. The complete removal of acne scars is not possible with any of the available methods and we state the aim of treatment in those terms as early as the qualification stage.

Pixel RF microplasma — a new method at our clinic

We have recently acquired the device Alma Beauty SpaDeep with the microplasma handpiece Pixel RF. In the treatment of acne scars it has one important advantage over a laser: it is not light, so melanin does not absorb its energy. We perform the procedure in patients of all skin phototypes, also on tanned skin and throughout the year, which makes it possible to conduct treatment in the summer as well.

Prices

Medical visit – dermatological examination: 280–350 PLN
Ablative fractional Er:YAG iPixel 2940 nm laser – cheeks: from 800 PLN
Ablative fractional Er:YAG iPixel 2940 nm laser – forehead: from 600 PLN
Ablative fractional Er:YAG iPixel 2940 nm laser – whole face: from 1600 PLN
Ablative fractional Er:YAG iPixel 2940 nm laser – décolletage: from 1000 PLN
Platelet-rich plasma: 900 PLN
PQ Age peel: 400 PLN (a series of 4 procedures – 1400 PLN)

The full list is available on the page HappyDERM price list.

Frequently asked questions

Can scars be treated while the acne is active?

We do not recommend it. During active inflammatory lesions a further scar may arise at the site of every new papule, and the effect of the procedures is undone. We first treat the acne and then plan procedures on the scars.

How many procedures are needed?

A series of 3–5 procedures every 4–6 weeks is usually planned. The number of procedures depends on the type and depth of the scars and on the response of the skin, so we set it individually and review it during treatment.

Can acne scars be removed completely?

No. None of the available methods restores the skin to its state before the disease. The aim of treatment is to make the scars shallower and to even out the surface of the skin to a degree noticeable in everyday lighting.

Is post-acne pigmentation treated in the same way as scars?

No. Post-inflammatory pigmentation and erythema are not scars and resolve spontaneously within 6–12 months. Management covers sun protection, lightening preparations and, in the case of erythema, a vascular laser.

When is the best time to begin treatment?

We plan laser procedures for the autumn and winter period, when sun exposure is lower. The skin must not be tanned, and consistent sun protection is required after the procedure.

Is the procedure painful?

We perform the procedure under local anaesthesia in the form of a cream. Patients describe the sensation as heat and pricking of moderate intensity, subsiding within 1–2 hours after the procedure.

How to prepare for the consultation?

Please come without make-up and prepare information about the treatment of your acne so far, in particular about taking isotretinoin together with the date on which the therapy ended. Photographs of the skin from the period of active disease are helpful.

Can one return to work the day after the procedure?

Directly after the procedure erythema and swelling persist, and over the following days visible peeling. A return to everyday activities without clear traces is usually possible after 5–7 days.

The doctors who perform the procedures

Qualification and the procedures are conducted by dr n. med. Małgorzata Micał-Strąk and lek. Ireneusz Pijanowski.

Booking a visit

An appointment for a consultation can be booked by telephone on 573 290 488.

Telephone booking: 573 290 488. The contact details of all the clinics are available on the page contact.