POST ACNE FACIAL SCARRING:
What is post acne facial scarring?
The common form of acne seen in teenagers and young adults is called acne vulgaris.
This is commonly treated by a Dermatologist, who is an Internal Medicine specialist treating diseases of the skin.
Active acne is treated with topical creams and medication taken by mouth.
There are varying degrees of acne severity . Some cases are mild and leave little or no significant facial scarring. Other more severe cases can leave a variety of facial skin deformities including scarring, dents, dimples, contour abnormalities and pigmentation changes.
Once the acne has burnt out, and there is no further active disease, there are surgical options to treat the cosmetic deformities that may have occurred from the acne.
What can be done surgically to improve post acne facial scarring?
Scar revision:
A deep wide pore, or a skin depression produced by a scar is difficult to camouflage with makeup because of the irregular skin surface over the scar.
This can be treated under local anaesthesia (freezing) by excising the scar and closing the defect with surrounding normal skin using stitches. Once healed, the depressed scar is replaced with a very fine straight scar easily camouflaged with makeup.
Dermabrasion:
In more extensive cases where there are numerous areas of facial scarring, a procedure called Facial Dermabrasion is a consideration.
This procedure can be done under Local anaesthesia (freezing) if the area is fairly limited or under General Anaesthesia if a full face is being treated.
The irregular topography (surface) of the skin produced by the facial scarring cast’s irregular shadows from overhead light which exaggerates the irregular skin appearance.
A special medical tool called a dermabrader smooths the skin surface, somewhat similar to sanding down a rough piece of wood to make it smoother.
The depth of the dermabrasion is carefully controlled in order to avoid violating the deeper layers of the skin dermis which could produce scarring. The dermabrasion depth reaches the superficial layer of the skin dermis where fine bleeding is produced (similar to an abrasion you get if you fall on your knees on an asphalt road).
For this reason, very deep acne scarring is improved but not eliminated.
Often a dermabrasion may have to be repeated once, and sometimes twice, to get the desired effect.
After the surgery is completed, a special dressing and moisturizers are applied until the dermabraded areas heal. It takes 7 – 10 days for all the scabbing to disappear.
The patient is left with fairly bright red – pink healed fresh skin which is smoother and wrinkle free.
The pink color fades over a period of 3- 6 months. The pink color can be camouflaged with makeup during this healing period.
The healing skin is very vulnerable to sun exposure during the first 6 months after surgery. Sun exposure during this time may produce increased pigmentation in the dermabraded areas, which may persist for years. For this reason, dermabrasion is often done in the late fall to early spring seasons.
Dr.Giuffre strongly recommends sun block protection during the healing period following a dermabrasion.
Facelift:
In more severe cases of post acne facial scarring, in addition to a dermabrasion option, some patients will benefit from a facial skin tightening procedure called a Facelift.
When a patient with severe facial scarring pulls the skin of the cheeks toward the ears, the skin irregularities smooth giving an improved appearance. This is what a facelift does.
The opposite effect can be produced by moving the skin of the cheeks toward the nose and mouth. This exaggerates the irregular contour of the skin. This manoeuver mimics the effect of gravity on the face over time. A patient with severe post acne facial scarring will have an exaggeration of the irregular appearance as time passes and gravity affects the face.
In this instance, a facelift procedure on a younger person may provide a significant cosmetic improvement to the facial skin.
Because gravity continues to affect the skin, a retightening procedure is often necessary as time progresses in order to maintain the improved effect of skin tightening.
Dr. Giuffre will discuss all of the option combinations and demonstrate these manoeuvers during the consultation discussion with the patient.
What about having my Cosmetic Surgery in another country where it is cheaper?
There is a current trend to have surgery out of your country where the surgery may be cheaper.
We call this tourist surgery.
There are a number of additional risks associated with tourist surgery, which include:
The surgical skill, experience, licensing and education of an unknown surgeon.
Canada has very strict rules and requirements to be a licensed Plastic Surgeon (FRCS(C)) in our country. Your Plastic Surgeon has completed an undergraduate degree (4 years), an MD degree (4 years), a Fellowship Degree in Plastic Surgery (5 years) and often a post Fellowship (1-2 years).
A “friend” is not a good reference, nor is glitzy advertising.
The safety, sterility and equipment quality, including anaesthesia machines in the hospital or private surgical suite could be questionable; this may lead to increased risk of infection and anaesthetic risks.
Post operative care is limited to the time you spend in their country.
If you have a complication, to see your original surgeon, you will have to fly back to where your procedure took place, or see a new surgeon in your own Country.
If you have an unsatisfactory result, you will have to fly back to see your original surgeon or find a new Surgeon.
The cost of the repair may exceed what you originally paid, and the final result, fixing a mistake, is often not as good as it could have been had the surgery been done correctly the first time.
After accounting for the accumulated costs of the air travel, hotel, surgery and postoperative care, the perceived cost savings may not be significant.
If you have a severe, life threatening complication, Alberta Health Care will cover the medical costs for your care.
Correcting the reconstructive problem, as a result of the complication, would be the patient’s financial responsibility.