In most acne scars there is a loss of skin volume (atrophy), which gives the area where they form a depressed or “etched” appearance. This atrophy is the product of a lack of hyaluronic acid and collagen in the dermis, the intermediate part of the skin, responsible for giving the turgidity, volume and elasticity of healthy skin.
There are different methods to treat atrophic scars, which we could classify into two different groups according to their speed of action:
· Immediate effect. They are called fillers, biocompatible substances that can be injected into the skin to give volume to areas that have lost it. Among them, those of hyaluronic acid, polylactic acid or calcium hydroxyapatite stand out among others. Its turgid effect is immediate, filling cavities, furrows and atrophic areas of the skin with very natural results. The duration of these materials is limited, so periodically (every 6 – 18 months) it is common to practice a new session.
· Delayed effect. It implies that they promote the synthesis of collagen and ground substance of the dermis. Fractionated lasers (ablative or non-ablative) and intermediate and deep peels should be highlighted. The main advantage of these methods is that their effect is permanent once the optimal point of improvement has been reached, which is not immediate but after practicing several sessions of the procedure. If you want to learn more about the non-ablative fractional laser click here.
Hyaluronic acid is indicated in the treatment of atrophic, depressed and ice pick acne scars. There are different densities of hyaluronic acid, designed to treat different forms of atrophy or loss of volume. For the treatment of moderate or ice pick acne scars, it is useful to use low and intermediate densities; and to recover a large volume in especially atrophic areas, it is possible to use higher densities to cover the maximum repertoire of defects.
The main advantages of using hyaluronic acid lie in its immediate action, its durability, its biocompatibility and its minimal allergenic potential. This molecule has the ability to fill in atrophic scars, providing optimal volume immediately and in the short term, promoting collagen synthesis in the long run. In this way, the irregularity on the surface of the skin is substantially reduced after the application of hyaluronic acid, improving the overall appearance of the skin in the treated area.
Another positive aspect of using hyaluronic acid is that it usually only requires a single application session. Likewise, fillers are one of the best tolerated aesthetic procedures since they have a minimal rate of adverse effects and the pain caused is minimal if a precise technique is followed. A slight erythema (redness) that lasts 2-4 hours after the procedure is common and can be reduced with the application of cold compresses.
The only limiting aspect of hyaluronic acid fillers is their duration. This molecule is naturally degraded in the skin, its effect persisting for a period of 6-18 months depending on the density of hyaluronic acid used and the indication for which it has been applied. Specifically, for acne scars, the duration of hyaluronic acid is the maximum possible, since it is retained within the fibrosis that partitions the scars. It should be remembered that, in the long term, this molecule favours the synthesis of collagen, so that the perceptible effect is progressively more durable as different sessions are carried out.
What is the main indication of hyaluronic acid in acne scars?
Its main effect is to fill in depressed scars and regularize the appearance of the skin surface.
When is the effect of hyaluronic acid noticeable?
The effect of hyaluronic acid is immediate and noticeable at the end of its application. Over a week or so, the hyaluronic acid settles in the applied area and the surface where it has been applied progressively becomes even more regular.
How is hyaluronic acid applied?
The procedure is performed through microinjections applied under the scars to be treated. An anaesthetic cream is usually used prior to the session and it is very tolerable, with minimal discomfort.
How many hyaluronic acid sessions are needed to treat facial acne scars?
In general, if they are not very deep or extensive, one is enough.