Acne - is Laser Surgery the Answer?

Everyone knows what acne is. Zits. Pimples. An odd disorder that strikes when you are a young teenager and socially most vulnerable. It seems to sense when you're preparing for an important date, job interview, or meeting your girlfriend's parents - that's when it strikes.

I suffered from acne as a teenage girl and was left with scars - pits in the skin. It's 45 years later, and I still get an occasional breakout. As a girl, I tried everything I could get my hands on: strong soap, constant scrubbing - I didn't have a dead skin cell anywhere between my ears. Someone told my mother, "Try carbolic acid." For six months I applied carbolic acid. It burned. The acne sneered and continued to ravage my face. Someone else told my mother, "Have her wash her face in her own urine." For three months or more, I washed in my own urine. Nothing helped.

Acne is truly a scourge. More than the facial scars, it's the unwelcome attention it brings you that hurts deep down where you live. Every negative comment, every time you catch someone staring at you ("Oh, that poor girl") another wound is piled on.

We didn't know anything about retinoids, dermabrasion, the "pilosebaceous unit," or lipids in those days. Today there are about as many treatments for acne as there are spots on your face at any one time - the newest and most promising (according to some sources) is laser surgery. But does it work?

First let's look at what happens to produce acne. Acne is inflammation, pure and simple, of something called "the pilosebaceous unit." What that means is that the tubes in the skin that bring oil (sebum) to the outside have become blocked and infected, either because their cells are abnormal or due to the action of bacteria. The infection causes scarring on the top layers of the skin or deeper down. Abnormal cells in the gland and tube (duct) can be caused by hormones, overproduction of oil, and toxins produced by the body or by the bacteria. The aim of treatment is to unblock the tube, destroy bacteria, and bring the level of oil production to a manageable level.

Many sufferers have noticed that their acne improves with exposure to sunlight or ultraviolet light. Light has a beneficial effect on the chemicals and processes that make for healthy, zit-free skin. From there it is only a small step to laser surgery. But before you opt for treatments, there are some things you should know:

PROS

Traditionally, acne has been treated with creams, lotions, cleansers, astringents and antibiotics. These have worked sporadically. These days, the preferred treatment is "non-ablative (ablative means "high heat") laser treatments.
Laser treatments for active acne have only come on the scene in the last several years, after it was noticed during laser treatments for scarring produced a reduction in the active acne as well. Lasers are also being used for removing unwanted hair, smoothing wrinkles away, and removing birthmarks. When lasers were first used in acne treatment, they didn't work very well, especially on darker-skinned people, who were left with ugly scars. These problems have largely been eliminated. The lasers themselves have been improved, and doctors have received training in their use. Dark-skinned people have found that treatment using combined light and radio frequency ("Do you want music with that?") gives good results. Radio frequency energy tightens the skin, while light rays kill the bacteria, and the laser works to heal. Of all the currently available treatments for ongoing acne, the laser has been proven the most effective.

The scars left by acne are of particular interest in discussing treatment. With acne scars comes a loss of color in the skin, causing the scars to stand out on the face. Laser technology is especially helpful in this area, as it restores pigmentation to the skin with a technique that brings the scar's color back to match the rest of the face. Using these techniques, dermatologists are able to penetrate deep into the skin, reaching the cells that have been lying dormant and waking them to action. The result is that the scarred tissue becomes smoother and closer in texture to the surrounding skin.

There are several types of acne scars, both caused by the way the surrounding tissue reacts to the inflammation - by growing more tissue, or by removing tissue. "Hypertropic" and "keloid" scars are caused by increased tissue formation - an accumulation of collagen. Keloid scars look like closely grouped blisters, the kind you see in severe sunburn. This appears to be genetic. If you have keloid scars, you can bet that your parents or grandparents did, too.
"Loss of tissue" scarring is much more common. There are several types:

oDepressed fibrotic scars: Real craters just like you see on the moon, with sharp sides and obvious margins. These scars are very obvious.

oIce-Pick scars: These resemble a puncture wound, with sharp sides. They may be superficial or deep.

oAtrophic macules: Flat, soft scars of a bluish or violet color on white skin, reflecting the color of the blood veins below. These tend to lessen over time.

oSuperficial and soft, deep scars: different sizes with sloping margins that blend well with the rest of the skin. This type scar is less noticeable.

In an comprehensive plan for skin repair, both the ongoing acne and the scars from previous bouts with acne will be treated. Treatment modalities may include a chemical peel, dermabrasion, steroid injections, or "excisional" surgery, where the scar itself is removed, but scar removal using the laser seems to work best.

Chemical peels work well on smaller scars, and on some large scars. It is also efficient in doing away with blackheads and whiteheads. It is not recommended for use with ice-pick scars or fibrotic scars, or with keloids, nor will it usually do the job with deep, deep scarring, unless repeated several times.

Dermabrasion penetrates more deeply than the chemical peel. In the past, it was not indicated for ice-pick scars because once the top layer of skin was removed, a bigger fibrotic scar was often revealed below. New techniques have been developed with some success in treating ice-pick scarring.
But the King of acne scarring treatment is now the laser, say its proponents. Different types of lasers are used for different types of acne scars. The YAG laser and the carbon dioxide laser work well on irregular scarring and to tighten the collagen fibers to bring depressed scars up to the level of the surface.

There is no doubt, laser treatments are expensive. If you shop around you may find a lower price, but you MUST be sure to check out the doctor thoroughly. How many of these procedures has he done; what associations does he belong to (check out his diplomas); does he have any before-and-after photos; how long will it take for you to heal, etc., because there are risks, and here they are:

CONS

According to a study published in the Journal of the American Medical Association (JAMA), more research must be done before all is known about the effects of laser surgery on acne and acne scars. While laser treatment has been shown to improve the problem, researchers felt that more studies needed to be done.

In this study, Jeffrey Orringer, M.D. and others of the University of Michigan Medical School looked at the efficiency of pulsed dye laser surgery in treating acne. The 40 patients studied received 1-2 treatments on one side of the face. Over 13 months of study, they were tracked for breakouts using lesion counts and "before-and-after" photographs. No significant improvement as a result of the laser surgery was found.

"The fact that our study does not substantiate the positive results recently reported [in other studies] is not an indictment of laser therapy for acne in general, and does not necessarily rule out the possible role of this particular pulsed dye laser. However, it does suggest that additional well-designed studies are needed before the use of the pulsed dye laser becomes a part of acne therapy,"

the authors reported. This particular type of laser - pulsed dye - does not penetrate deeply, they admitted.
Some anecdotal evidence might help people who are contemplating laser surgery to make up their minds. Over a sampling of 105 people who had it done, 2% gave it two smiley faces (out of a possible five) for efficiency of treatment; 2.2% gave two smiley faces for "agreeability," and 2.1% awarded the treatment two smiley faces for "affordability." In other words, these 105 people didn't care for the treatment. Their comments are worth noting.
One person from New York reminded everyone to check out several doctors very carefully before choosing. "Make sure he/she is a member of the board of plastic surgeons (legitimate)…don't just go by word of mouth. Some of these people are not fully qualified to do these procedures or have a bunch of lawsuits against them that you may not know anything about," they said.

Another person, from Cleveland, reported that their surgeon insisted that the entire face be done, instead of just the affected areas, in order to promote an even skin tone. "I know I need to be patient here," said the Clevelander, "but I look like a total monster, and worse, I have completely broken out because I have to stay covered in greasy antibiotic ointment." This person contacted the doctor and was told to be patient, that she would be better soon. It didn't happen. "He probably has never suffered from acne and doesn't understand that more acne = more scars, and I've just spent a bundle trying to minimize them."

Other laser surgery survivors reported the laser left lines on their faces. Vince from California tried RetinA, benzoid peroxide and Accutane but his problem only worsened. Friends recommended laser surgery from a certain company; he went there and found he needed 10 treatments at $1,000 each. "Anonymous" reported that after two laser treatments, the skin of the face looked worse than ever - "After the first treatment, my skin just errupted [sic]", this user reported. "So when I went in for my 2nd treatment and asked if this was a normal response and I was told that yes sometimes the lasers bring all the "gunk" up to the surface and can make your skin worse. Fisrt [sic] off, what… kind of explanation is that from a highly educated docter [sic] and secondly, thanks for not mentioning that before the treatment! After my 2nd treatment my acne is still bad and now I have scars that I never had before…"

There is more, but I won't include it all here. If you are thinking about laser treatment for your acne or acne scars, do your homework. "Acne" and "acne treatment" typed into your search engine will give you plenty of information. Check the doctor out thoroughly, ask how many procedures he has done and how long you will heal, plus ask him to describe any problems you might run into afterward.

If you are satisfied, proceed, and the best of luck to you.