Spots and Scars-What to do?
Most people can relate to spots and scars which can occur anywhere on the body. Spots and scars are due to any injury on the skin. It can be from acne, sun damage, an infection (such as a boil, severe dry skin from eczema, psoriasis), skin conditions that causes ulcerations and patches, bug bites, ingrown hairs, picking at the skin, etc. There are so many reasons I can't list them all but you get the picture. The skin got hurt and it left a mark. This happens because when the skin is injured, cells that provide color in our skin the melanocytes become too active and lay down extra pigment. If you have very fair skin, it will look red to light brown. If you have more olive to light brown complexion, it will look light to dark brown. If you have more brown to black skin, it will look more brown to black but darker than your normal skin color always. The medical terminology for this is post inflammatory hyper pigmentation (PIH).
It is important to understand what caused the spot or scar in the first place to understand what treatment is the best. The most important thing to do is stop the injury from occurring in the first place. If it is from acne, we need to treat the acne. For more information on that refer to the acne blog. If it is dry skin or ulcerations, the cause of this needs to addressed and the skin needs to be intact before any other treatment can be started. The most common cause for spots is usually from sun damage and from acne scarring.
What I do for this is start on good skin care products. We need to use products that will exfoliate the skin and lighten the spots/scars. Two items that will exfoliate the skin are alpha hydroxy acids and retinols. The skin cycle which is the renewal of new skin that matures and comes up to the surface of the skin to be sloughed off is 6 weeks long. As we age, the percentage of skin that turns over or exfoliates every cycle begins to diminish. When we are young, most of our skin exfoliates every 6 weeks leaving healthy, glowy skin. As we begin to age or if we have skin problems, this process slows down leaving more dull, irritated skin.
Alpha hydroxy products expedite the exfoliation process to keep the skin looking healthier and younger. Retinols penetrate deeper to exfoliate and if used for over one year with consistency, can actually correct any damaged DNA to leave the skin looking radiant. It does take one year of use at 0.1% strength to achieve this. The typical prescription is for 0.025% or 0.05% only. In fact, studies on transplant patients show a reduction in skin cancer using retinols at high strengths, so I am a firm believer in using Retinols for not only problem skin, but for wrinkle correction and prevention as well as for the prevention of skin cancer. (No, it will not protect you if you continue to be a sun worshipper!) . Using exfoliation products will cause lightening of the spots/scars over time. This does take about 6-9 months to see the results with products alone. Retin-A is contra-indicated in pregnant and breast feeding women.
I also use lightening creams/gel and Vitamin C. Lightening Gels/Creams are from Hydroquinone 4%, which is prescription strength to use two times daily to the affected area. If it is really bad, wait five minutes and reapply it in 5 minutes to get optimal results. Most people will need 3 months to see optimal results. Hydroquinone is contra-indicated in pregnant and breast feeding women.
I love using Vitamin C serum to brighten the skin and it helps prevent wrinkles! It is the only product out there that will do that. Vitamin C must be at the right pH, right molecular structure, and a clear serum for it to work well. There are many products that claim to do a great job but have no studies behind it. Skinceuticals and Obagi have great Vitamin C serums. I like Obagi better because you can use it on the eyes. The eyes are where everyone starts to age and for many of us, this is where dark circles from chronic sleep deprivation, genetics, etc begin. Vitamin C does not make these circles go away, but can soften and blend the color closer to your natural skin tone. I use Vitamin C daily around the eyes and 3 times per week to the full face. My patients always ask me if their oral Vitamin C will work. If you took 25 pills of 500mg of Vitamin C a day then maybe but the one to two pills that people take will not do it. Vitamin C stops free radicals from causing destruction to the skin. The skin does super saturate with it so you do not need to use it everyday, but many people do because they love the way their skin looks. It does take about 3 months to see good results with this as well.
For the treatments of spots and scars, it will depend on how long they have been there, are they indentations or pick marks deep in the skin, and any other conditions you may have. The longer they have been there, the deeper they are. If you have some superficial spots that have been there less than a few months, high strength chemical peels and aggressive medical dermabrasion may work for the face. For the rest of the body, I usually recommend lasers and microderm treatments because the skin is usually thicker and does not respond as quickly.
To understand how deep things are, let me tell you that for acne scarring and pits, that scar mark is about 800microns deep in the skin. The best laser out there penetrates about 150microns so that is why repeated treatments are necessary. Think about an indentation in the skin as a big pot hole in the skin. This pot hole is usually treated in three ways. It can be filled with something temporarily, the skin around it can come down so it looks less noticeable, or it can be filled with new collagen and elastin to be a more permanent solution.
To fill the scar, we can use a filler such as Restylane, Juvaderm, Radiesse or Sculptra. The first two last about 6 months and the latter two, last 1-2 years. You will need to return back to get this filled regularly just like the pot hole does every year. Option two is a resurfacing laser. This is a procedure that requires sedation and down time for a week to 3 weeks depending on how deep they went. The resurfacing laser removes all of the skin and lets new skin grow back. To go back to the pot hole analogy, the whole road around the pot hole got taken off and then it was slowly filled. It does not always fix the very deep scars because they do not get filled. It is rather the skin around it came down so it looks less obvious. The third option is a fractional resurfacing. This uses similar technology as the latter but there is only a weekend of down time and it actually fills the pot hole with new collagen and elastin. It does take time to get optimal results because the marks are deep.
For patients with spots secondary to sun damage-using an intense pulse light or the fractional resurfacing laser are two great options. Once again, the difference is how long has it been there and how deep is it. The deeper it is, the more treatments it requires and the better you will do with the one that penetrates deeper in the skin-the fractional resurfacing laser is my choice.
For scars that come from trauma-bug bites, boils, dry skin, etc, the resurfacing laser is our best treatment. But once again, using the skin care products is complementary to this and it will take time.
Spots and scars are a long topic and cover a lot of different problems. This I hope will at least provide you with some preliminary background to help you understand the choices out there and also to differentiate what people are just trying to sell to you. I really think a lot of my patients with bad scarring will try anything but not everything will work. The best thing to do is do your homework, go and talk to the specialist, see what they offer, see what results they have gotten, and have them answer all of your questions! Make an informed decision and give it a try. I really do think these treatments help soften and blend down spots and scare but people just have such unrealistic expectations of what will happen. It is important to understand that you will not achieve perfection as much as an improvement. [
It is important to understand what caused the spot or scar in the first place to understand what treatment is the best. The most important thing to do is stop the injury from occurring in the first place. If it is from acne, we need to treat the acne. For more information on that refer to the acne blog. If it is dry skin or ulcerations, the cause of this needs to addressed and the skin needs to be intact before any other treatment can be started. The most common cause for spots is usually from sun damage and from acne scarring.
What I do for this is start on good skin care products. We need to use products that will exfoliate the skin and lighten the spots/scars. Two items that will exfoliate the skin are alpha hydroxy acids and retinols. The skin cycle which is the renewal of new skin that matures and comes up to the surface of the skin to be sloughed off is 6 weeks long. As we age, the percentage of skin that turns over or exfoliates every cycle begins to diminish. When we are young, most of our skin exfoliates every 6 weeks leaving healthy, glowy skin. As we begin to age or if we have skin problems, this process slows down leaving more dull, irritated skin.
Alpha hydroxy products expedite the exfoliation process to keep the skin looking healthier and younger. Retinols penetrate deeper to exfoliate and if used for over one year with consistency, can actually correct any damaged DNA to leave the skin looking radiant. It does take one year of use at 0.1% strength to achieve this. The typical prescription is for 0.025% or 0.05% only. In fact, studies on transplant patients show a reduction in skin cancer using retinols at high strengths, so I am a firm believer in using Retinols for not only problem skin, but for wrinkle correction and prevention as well as for the prevention of skin cancer. (No, it will not protect you if you continue to be a sun worshipper!) . Using exfoliation products will cause lightening of the spots/scars over time. This does take about 6-9 months to see the results with products alone. Retin-A is contra-indicated in pregnant and breast feeding women.
I also use lightening creams/gel and Vitamin C. Lightening Gels/Creams are from Hydroquinone 4%, which is prescription strength to use two times daily to the affected area. If it is really bad, wait five minutes and reapply it in 5 minutes to get optimal results. Most people will need 3 months to see optimal results. Hydroquinone is contra-indicated in pregnant and breast feeding women.
I love using Vitamin C serum to brighten the skin and it helps prevent wrinkles! It is the only product out there that will do that. Vitamin C must be at the right pH, right molecular structure, and a clear serum for it to work well. There are many products that claim to do a great job but have no studies behind it. Skinceuticals and Obagi have great Vitamin C serums. I like Obagi better because you can use it on the eyes. The eyes are where everyone starts to age and for many of us, this is where dark circles from chronic sleep deprivation, genetics, etc begin. Vitamin C does not make these circles go away, but can soften and blend the color closer to your natural skin tone. I use Vitamin C daily around the eyes and 3 times per week to the full face. My patients always ask me if their oral Vitamin C will work. If you took 25 pills of 500mg of Vitamin C a day then maybe but the one to two pills that people take will not do it. Vitamin C stops free radicals from causing destruction to the skin. The skin does super saturate with it so you do not need to use it everyday, but many people do because they love the way their skin looks. It does take about 3 months to see good results with this as well.
For the treatments of spots and scars, it will depend on how long they have been there, are they indentations or pick marks deep in the skin, and any other conditions you may have. The longer they have been there, the deeper they are. If you have some superficial spots that have been there less than a few months, high strength chemical peels and aggressive medical dermabrasion may work for the face. For the rest of the body, I usually recommend lasers and microderm treatments because the skin is usually thicker and does not respond as quickly.
To understand how deep things are, let me tell you that for acne scarring and pits, that scar mark is about 800microns deep in the skin. The best laser out there penetrates about 150microns so that is why repeated treatments are necessary. Think about an indentation in the skin as a big pot hole in the skin. This pot hole is usually treated in three ways. It can be filled with something temporarily, the skin around it can come down so it looks less noticeable, or it can be filled with new collagen and elastin to be a more permanent solution.
To fill the scar, we can use a filler such as Restylane, Juvaderm, Radiesse or Sculptra. The first two last about 6 months and the latter two, last 1-2 years. You will need to return back to get this filled regularly just like the pot hole does every year. Option two is a resurfacing laser. This is a procedure that requires sedation and down time for a week to 3 weeks depending on how deep they went. The resurfacing laser removes all of the skin and lets new skin grow back. To go back to the pot hole analogy, the whole road around the pot hole got taken off and then it was slowly filled. It does not always fix the very deep scars because they do not get filled. It is rather the skin around it came down so it looks less obvious. The third option is a fractional resurfacing. This uses similar technology as the latter but there is only a weekend of down time and it actually fills the pot hole with new collagen and elastin. It does take time to get optimal results because the marks are deep.
For patients with spots secondary to sun damage-using an intense pulse light or the fractional resurfacing laser are two great options. Once again, the difference is how long has it been there and how deep is it. The deeper it is, the more treatments it requires and the better you will do with the one that penetrates deeper in the skin-the fractional resurfacing laser is my choice.
For scars that come from trauma-bug bites, boils, dry skin, etc, the resurfacing laser is our best treatment. But once again, using the skin care products is complementary to this and it will take time.
Spots and scars are a long topic and cover a lot of different problems. This I hope will at least provide you with some preliminary background to help you understand the choices out there and also to differentiate what people are just trying to sell to you. I really think a lot of my patients with bad scarring will try anything but not everything will work. The best thing to do is do your homework, go and talk to the specialist, see what they offer, see what results they have gotten, and have them answer all of your questions! Make an informed decision and give it a try. I really do think these treatments help soften and blend down spots and scare but people just have such unrealistic expectations of what will happen. It is important to understand that you will not achieve perfection as much as an improvement. [
Labels: acne, ardmore, botox, Laser hair removal, laser skin rejuvenation, medical spa, optimal health, optimalhealthtoday.com, PA, philadelphia, restylane, seema patel MD, shanti, skin, skincare
posted by Seema Patel MD, MPH @ 12:06 PM
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