Advanced Acne Treatment
As most patients with acne know, acne is a very difficult and frustrating condition to treat. The majority of patients have pursued numerous treatments throughout their lives, resulting only mild improvement. The treatment efficacy varies significantly from patient to patient, and the treatment regimens are quite different from one medical office to another.
Although some patients may benefit greatly from a single type of remedy, most require a combination of treatment modalities to obtain the most significant improvement and control. At the Beverly Hills Center for Plastic & Laser Surgery, Dr. Ben Talei, a dual board certified facial plastic surgeon is able to combine medical, laser (non-surgical) and surgical treatments to provide the most advanced outcomes. We also work very closely with our dermatology colleagues who are leading professionals in this field to ensure the most effective, long-lasting results.
Why Do I Have Acne?
Acne is in part caused and worsened by specific types of bacteria, but the majority of the predisposition to acneiform skin comes from each individual’s skin characteristics. Skin types that are prone to acne vary but are most typically those with very active pilosebaceous units and overall hyper-reactivity. This means that these skin types typically provide a nice environment for the growth of harmful bacteria. When the skin becomes irritated, it demonstrates an exaggerated reaction when compared to more tranquil skin types. Some of the issues related to acne, such as “ice picks,” “boxcar scars,” and “rolling scars” may be very difficult to treat. Certain “craters” may be a result of excessive treatment with steroids. Steroids such as triamcinolone (Kenalog) cause tissue atrophy. They do so very effectively because they are particulate steroids, meaning they deposit small particles into the tissues that aren’t washed away like other soluble medications.
- Medical Treatment for Acne
- Treatments for acne consist of both topical and oral medications. A specialized dermatologist typically best manages medical therapies. The most successful doctors are most often prepared to try a variety of treatments in order to find the most suitable type for each individual. The goal of these medications varies, but they can be used to target bacterial growth, redness, rosacea, hyperpigmentation, skin quality, clogging of pores and pore size.
- An oral medication, such as Accutane (isotreinoin), is one of the most effective available and has a few limitations that patients should be aware of. Topical retinoids, such as tretinoin (Retin-A), are very helpful in improving skin quality and increasing skin turnover. May other medications such as benzoyl peroxide, vitamin C, salicylic acid and azelaic acid have also shown some benefit. A variety of combinations of antibiotics such as doxycycline and clindamycin have shown wonderful results as well. Depending on the patient, chemical peels can provide significant improvement for many patients. We are continuously learning and developing the most novel and cutting-edge treatments to see if they can help us better improve and treat our patients.
- Laser Treatment of Acne
- Lasers have shown great promise for mild to severe cases of acne. The specific type of laser used depends on the goal of treatment. While certain lasers can be used to lessen the appearance of ridges and cavities, others can be used to improve skin texture and color. Pore size can also be improved with certain treatments.
- For resurfacing, the most effective laser we have seen in our practice is the fractionated CO2 laser. This is an ablative laser, which does require some downtime. This is especially in patients with acne who tend to have an exaggerated healing response. For those patients who are unable to sustain the downtime, they have the option of performing repeat treatments using either fractionated Erb:YAG (2940) or Erb:Glass lasers (1540). The effect of these lasers is not as pronounced after a single treatment, but significant improvement is seen after a short series of treatments with little to no downtime.
- In order to treat pigmentary changes, a variety of lasers and lights are available. These include IPL (intense pulse light), filtered IPL with much higher power, pulse dye lasers and a number of others available to treat areas of redness or blotchiness. The laser type most suitable to you can only be determined after consultation with a specialist.
- Surgical Treatment of Acnes
- What most patients don’t realize is that surgical treatment of acne is available especially for the more severe and resistant cases. The most straightforward treatment is to address large depressions that have formed during cystic acne exacerbations or following steroid injection. Depressed and sunken areas of skin improve only marginally from needle-stimulation therapies.
- Given the amount of deep scarring, they are even less likely to improve with the use of facial fillers except in certain instances. Although depressions may improve with chemical peels, dermabrasion or laser treatments, some of these regions must simply be removed by excision and closure. What one must be aware of is, although most acne-forming skin tends to heal over quickly following excision and closure, it also has a tendency to demonstrate a prolonged period of redness. This is until healing has more thoroughly occurred.
In select patients, especially those with heavy anterior cheeks, deep plane cheek and face lifting techniques have also shown great promise. This procedure varies significantly from standard face-lifting techniques that are used nationwide, as other types invariably fail to show any long-lasting results. Using this specific technique, we have successfully treated patients from 30 years of age and older. A deep plane cheek lift can spread and lessen the density of scars caused by acne. This procedure can effectively reposition heavy anterior cheeks to a more appropriate superior and lateral position. Our patients have been ecstatic about the results, especially when combined with laser resurfacing procedures.
At the Beverly Hills Center for Plastic & Laser Surgery, we offer the most advanced forms of acne treatments available. During consultation, we will thoroughly evaluate your skin type and give realistic expectations of the improvement you can receive. It is very rare for chronic acne skin to demonstrate full resolution. However, improvement is definitively seen, and our patients have been thrilled with the treatments and results they have not been able to obtain elsewhere. Dr. Talei understands the social pressures and stress that skin irregularities may cause, and our group is very attentive to your needs. Contact us today to schedule a consultation for you or a family member with Dr. Talei.