Thank you for your email about acne. Acne is one of the most common and frustrating skin conditions in the world. Good acne control is very important to prevent acne scars. Many people continue to have acne outbreaks into their 30’s so you are not unique. I am going to reprint below an article about modern effective skin care methods to prevent acne outbreaks and acne scars. You have to follow a good skin care routine completely to gain control over acne, but it is possible.

All of us who have ever had an acne sore or Comedone have found it very distressing. It is even more distressing for people who have many acne lesions which keep coming back. People who go on to develop acne scars are troubled by them for many years as scars left by acne are very difficult to conceal.

The good news is that modern medical methods of acne control are very good and can reduce outbreaks and lessen the chance of acne scarring. See improvement in acne control using modern skin care methods below:

Above: Before and after acne control treatment with microdermabrasion, topical Clindamycin and Retin A.

However, you will need to follow the skin care program fastidiously. You will also need to consult an expert dermatologist or plastic surgeon that is up to date and knows how to treat acne. You will need prescription medications. You will also need to have monthly exfoliation treatments by a medical aesthetician who is experienced in acne control treatments.

You also need to start early, at the first sign of an acne outbreak. Delaying treatment only gives the comedones the chance to worsen and possibly cause an acne scar.

What Causes Acne

Acne is caused by obstruction and infection of the oil glands in our skin. Our skin contains oil glands called Sebaceous Glands which secrete normal oil called Sebum which helps moisturize and protect our skin.

If Sebum production is too high, for example during adolescence, or skin debris like dead skin blocks the pore that drains the Sebaceous Gland, the Sebaceous Gland can become distended and obstructed so that oil builds up and distends the gland.

An obstructed, distended Sebaceous Gland provides an ideal place for bacteria to grow and create an infection. Once the Sebaceous Gland becomes infected, the skin overlying the gland becomes red, swollen, and painful, an acne lesion. A whitehead can form on the skin, which is essentially a small skin abscess, called an acne pustule.

Acne tends to occur most commonly in areas where oil glands or Sebaceous Glands are most plentiful, the area around the nose, forehead and chin, called the T zone, and the back.

What Causes Acne Scars

Visible scars are caused by destruction of the Dermis, the deep layer of the skin. When the Dermis is damaged and tissue is lost, a visible depression or scar appears.

Because the Sebaceous Glands extend deep into the Dermis, the infection in the Sebaceous Gland or Comedone causes infection and destruction of the surrounding Dermis. After healing a deep depression or scar forms because the supporting Dermis tissue has been lost.

How to Control Acne Outbreaks

The basic requirements for control of acne involve:

• Reduce oil production of the Sebaceous Glands
• Remove skin debris to prevent obstruction of the Sebaceous Glands
• Treat and prevent infection of the Sebaceous Glands

Topical Benzoyl Peroxide is an anti-bacterial agent and a skin drying agent. It is marketed as Brevoxyl Cream or Brevoxyl wash. It is the most commonly used product to control acne and is very effective. Benzoyl Peroxide reduces oil and helps prevent infection.

Vitamin A (retinoic Acid) derivatives reduce skin oil production by inhibiting the Sebaceous Gland cells. Products that are commonly used are Differin (adapalene), Retin A, Tazorac, and Accutane (isotretinoin). These prescription drugs are very effective but do have side effects like skin irritation dryness and other potential problems, thus they must be used under the direction of a physician.

Topical Clindamycin is the most effective antibacterial agent for controlling skin infection in my experience. It comes as a gel or cream or small wipes called Clindets, which I use most frequently.

Microdermabrasion is the most effective minimally invasive, no down time deep exfoliation method. Microdermabrasion treatments are essential to remove debris, open pores and prevent obstruction of the Sebaceous Glands and the development of a Comedone.

Oral Antibiotics like Minocyclene and other Tetracycline derivatives are widely prescribed for acne control. They can be effective, but my own prejudice is that it is very hard, if not impossible, for an oral antibiotic to reach a skin abscess like a Comedone. The skin abscess forms a thick wall of inflammation that is almost impossible for the oral antibiotic in the bloodstream to penetrate.

That is why I place so much emphasis on topical care to reduce oil production, deep exfoliation to remove debris and allow the oil out of the gland, and topical Clindamycin applied directly to the infected oil gland or Comedone.

IPL, Diode Laser and Blue Light Treatments can kill the bacteria Propionibacterium acnes (P. acnes) which cause the infection or Comedone and some can reduce oil or Sebum production. These therapies are effective when used properly.

Acne Control Program

The control program depends on the severity of the acne.

Mild Occasional Outbreaks

• Monthly professional medical grade microdermabrasion treatments
• Topical Benzoyl Peroxide-(Obagi Clenziderm MD penetrates the best)
• Clindamycin- Clindets for acute lesions

Moderate to Severe Acne

• Monthly to bi-weekly microdermabrasion
• Obagi ClenzidermMD Benzoyl Peroxide
• Topical Clindamycin-Clindets
• Retin A Derivative-in increasing order of strength-Differin, Retin A, Tazorac, Accutane
• Consider IPL, Blue Light or Diode Laser Therapy

Severe Cystic Acne

• Microdermabrasion
• Obagi Clenzidrm
• Topical Clindamycin Clindets
• Accutane
• IPL, Diode Laser or Blue Light treatments

How to Remove Acne Scars

Traditionally dermabrasion or surgical excision was used to remove scars. However, with the advent of laser resurfacing in the mid 90”s, laser resurfacing with the CO2 laser became the most common method. However, CO2 laser resurfacing required prolonged recovery, often caused the skin to lose color, and CO2 laser resurfacing only smoothed the surface of the skin and did little to improve deep acne scars caused by destruction of the Dermis by the acne infection process.

Deep ice pick scars still require a special surgical procedure called floating grafts followed by CO2 laser resurfacing for effective removal. During this procedure, under local anesthesia, a small circular punch or trephine is used to cut around, but not remove the ice pick scar. The punched area floats up above the surface of the surrounding skin. After 2 weeks, the protruding graft has taken, which means it has new blood supply and will survive. At this point, the CO2 laser is used to plane down the protruding grafts flush with the surrounding skin. The new graft closes the ice pick scar. This is the only method I have seen that effectively corrects ice pick acne scars.

New fractional non-ablative laser skin resurfacing lasers are able to significantly improve deep acne scars by building new collagen to replace the collagen lost in the Dermis by the Comedone infection.

These new fractional non-ablative skin resurfacing lasers do not break the skin thus no healing time is required. You will need at least 4 treatments scheduled 4-6 weeks apart. The laser energy is fractionated, that is broken up into many small beams that pass through the skin without injuring it, and heats the deep dermis to build new collagen to actually plump up the acne scar.

The fractional non-ablative resurfacing laser is a revolutionary advance in scar removal treatment.

Above: Before and after acne scar removal with Starlux 1540 fractional laser skin resurfacing scar removal (Palomar.)

Where Do You Find a Good Acne Care Program?

First, re-read this article and be armed with the facts about acne skin care. Many physicians just prescribe Minocyclene and do not understand the importance of a comprehensive approach to acne skin care.

I recommend that you consult two board certified dermatologists or plastic surgeons that have an interest in acne skin care. Check their websites, do they offer all acne related services.

It is important to find a doctor who offers microdermabrasion treatments and laser therapy in their office. That means they are up to date on current technology.

I also believe that it is essential that the physician have an excellent experienced medical aesthetician in their office. Most of your contact and the most important person in your program will be the medical aesthetician, and she needs to know what she is doing.

You are very unlikely to find the expertise you need in a walk in Medical Spa without a board certified doctor present to examine you and recommend a course of therapy. Physician supervised in the Medical Spa world usually means the doctor is actually at an office some distance from the Medical Spa and provides his/her supervision in the form of a phone call when something goes wrong.

Do your homework.

For more information on acne control or acne scar removal call 978-369-44999 or email us. Read our free newsletter to keep up on the latest information on laser and non-surgical skin care. Read Save Your Face to learn how to prevent facial aging.

Dr. Seckel
Concord, Massachusetts
Boston, Massachusetts

Fraxel laser skin rejuvination works well for acne scars. However Fraxel does cause post-inflammatory hyperpigmentation, especially in dark skinned patients. Palomar has releasd a new laser called the Lux1540 which also benefits acne scarring and the company claims there is less risk of post-inflaammatory hyperpigmentation.

Because of the risk of hyperpigmentation I do not recommend fraxel laser skin rejuvenation treatments on dark skin.

For more information on pigmentation removal, lasers and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

For correction of enlarged pores, acne and acne breakouts I recommend you see a medical aesthetician in a Dermatologists or Plastic Surgeons office and have a professional microdermabrasion-at least 4 to start.

I would also recommend Brevoxyl washes to reduce skin oil and a topical Retinoid-Differin or RetinA which will require a prescription.

The skin creams used in the Obagi Skin Care System is the best for Acne-call around and fined someone who carries it or go to Obagi.com to find a doctor.

After your acne and oily skin are improved with the Obagi system, the there are laser skin rejuvenation and IPL or photo facial treatments that can shrink the enlarged pores and help control acne breakouts. Palomar Lux1540, Smoothbeam, Blue Light, Clearlight, and lasergenesis are the names of some of the machines that are good. Check out the websites: Palomarmedical.com, Candella.com, Cutera.com, and Lumenis.com-they have information on their lase skin rejuvenation and IPL for Acne. A newer technigue called photodynamic therapy which combines IPL with topical levulon creamon the skin is a new effective acne treatment

For more information on acne, laser skin rejuvenation, IPL and photo facial and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

If you are concerned, and want the most gentle treatment for acne scars and enlarged pores I believe the LaserGenesis® is the most gentle, non-ablative laser treatment. Clearlight® by Lumenis® and Smoothbeam® by Candella® are two other effective acne treatments.

I recommend that you go to the Cutera®, Lumenis®, and Candella® websites and read up on LaserGenesis®, Clearlight®, and Smoothbeam® and see which treatment appeals to you the most.

If you have deeper acne scarring, a deep skin exfoliation like a laser skin peel or laser resurfacing, or Microlaserpeel®, Fraxel® or activefx laser skin peel may be required, but I prefer the less aggressive treatments first.

The most important thing is that you be under the care of an experienced board certified plastic surgeon or dermatologist who has experience in acne and acne scarring and who specializes in laser skin care and laser skin rejuvenation and who you trust, and then follow his/her advice.

For further information read Save Your Face or contact me. Thank you.

Dr Seckel

Boston, Massachusetts

You are not alone. Millions of people have acne and acne scars and just want to have normal skin.

There is no one cure that can create perfect skin.

However there is a great deal we can do today to help especially with the new non-surgical facial rejuvenation and laser skin rejuvenation techniques.

On the face I use Microlaserpeel® or activefx laser skin peels to create deep skin exfoliation to help with the acne scars. The neck needs to be treated more carefully with laser skin peels as the neck does not heal as well as the face.

A high intensity blue light treatment called Clearlight® by Lumenis® and a laser called Smoothbeam® by Candella® can be very helpful for acne and acne scars and I would be less worried about treating neck skin with these treatments. LaserGenesis® is another treatment that may help the scars, but the other 2 are better if you have active acne.

Recently the non-ablative laser skin rejuvenation treatments with LuxIR and Fraxel have had excellent results treating acne scars. These new therapies plump the acne scars by stimulating new collagen production deep in the dermis where collagen has been destroyed by the acne process.

Check out the Palomar, Lumenis®, Cutera® and Candella® websites to learn more about these treatments.

Be sure to consult a board certified plastic surgeon who is very experienced in Laser and light therapy and acne treatment.

In my opinion it is important to do deep skin exfoliation with laser skin peels first and then do deep collagen stimulation with the LuxIR or Fraxel after a few months healing from the laser skin exfoliating peel.

for further information on acne, acne scars, and laser skin rejuvenation, read Save Your Face or contact me.
Dr Seckel

Boston, Massachusetts

Fraxel is a good treatment for acne scarring but I would not recommend Fraxel® or any other ablative(ablate means to surgically remove) laser treatment or laser skin peel for acne scarring if red spots, rosacea, or broken blood vessels are a major pr0blem, especially on Asian skin. The problem is that Fraxel and other ablative lasers actually remove skin during the laser peel in an attempt to smooth the skin but when the skin is removed by a laser the red spots, broken blood vessels, and rosacea can become worse. Also, in patients with darker skin such as Asian skin, there is always the risk of hyperpigmentation with fraxel and later hypopigmentation or white patches on the skin, if the treatment goes too deep.

For Asian skin with acne scars and red spots, broken blood vessels, or rosacea I recommend a non-ablative laser skin treatment such as LaserGenesis® by Cutera® or Smoothbeam® by Candella®. If you have active acne, another treatment called Clearlight® by Lumenis® can be helpful. Newer acne scar treatments include the Lux 1540 by Palomar.

It is very important that you see a board certified doctor who is experienced in the use of lasers and laser skin rejuvenation and skin care for advice. This is especially important for people with Asian skin or dark skin, because if hypopigmentation occurs it cannot be corrected.

I hope this helps. For further information on acne scars, and laser skin rejuvenation visit drseckel.com read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Thank you for a very important question. I do feel LaserGenesis® is safe for black skin and is a good method to shrink enlarged pores.

Unlike other lasers there is no contact with the skin, thus the chance of injury to the skin, which could result in loss of pigment or hypo pigmentation and a noticeable light area on the skin, is very unlikely.

I have always been very conservative and not used other lasers on black skin because I fear injury and loss of pigment. Some doctors disagree with me but I always want to err on the safe side.

The LaserGenesis® because it is a non-ablative (does not remove skin) and no skin contact laser, is I believe safe for any dark skin, of course as long as it is being used by a board certified doctor who is experienced in lasers and the use of LaserGenesis®.

One great way to start the process to reduce pore size is microdermabrasion®. It is safe, not a laser, and much less expensive. It also is the best way to start.

The microdermabrasion® provides skin exfoliation of the skin and removes obstructions from the pores and lets excess skin oil out. This helps control oily skin and prevent acne break outs and reduce pore size.

Also I think LaserGenesis® will work better if the excess oils are removed from the oil glands first. LaserGenesis® works by building up collagen around the oil glands which presses on the oil gland openings (the pores) to make them smaller. If the excess oil has been removed by microdermabrasion® first, then there will be less work for the LaserGenesis® to do.

Also Brevoxyl Washes will help dry the skin, prevent acne break outs, remove oil and help the overall process.

Thank you very much for your question. For further information visit my Boston Plastic Surgery Practice, read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Peabody, Massachusetts

Dermabrasion may well ENLARGE the size of your pores and I would not recommend it. IPL or photo facial combined with a photo sensitizing agent, a technique called photo dynamic therapy, can reduce the size of enlarged pores.

There are many new better methods to treat acne scarring, among them Fraxel, Lux1540 and lasergenesis. LaserGenesis® is gentle, involves no contact with the skin, and causes no down time. It is helpful for acne scarring, fine wrinkles, red spots and vessels, and non-surgical facial rejuvenation and improved skin texture

Photo facial usually refers to IPL and is a very good treatment for pigment and blood vessels. Photodynamic therapy is different, involves a giving you a photo sensitizing cream and then using IPL. Photodynamic thereapy is a very good method for treating acne, many feel photodynamic therapy is the best method for treating acne.

For further information visit mt Boston Plastic Surgery Practice, read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Peabody, Massachusetts

I would not recommend Fraxel® for reducing enlarge pores. Fraxel is an ablative laser-ablative means that it removes some skin. When you remove skin, pore size can enlarge. Laser resurfacing can improve scars and wrinkles but pore size can be enlarged.

The skin pore is an opening to an oil gland deep in the skin, and the neck of the gland can be larger than the pore-thus if you remove the surface skin you can reveal the larger neck deep down. Fraxel® treatments can stimulate the growth of new collagen in the skin, and that can compress pores, but until I see published results demonstrating pore size reduction by Fraxel® I would not recommend it.

In addition, the red spots you mention could be made worse by an ablative laser.

Fraxel can be very helpful for acne scarring.

A laser made by Cutera® called LaserGenesis® is the one I recommend for reduction in pore size and improvement in acne scarring and it is very effective for removing red flush or red vessels. It also can help the fine line and wrinkles, stimulate new collagen production, and is a good non-surgical facial rejuvenation technique.

Of course you need to get the opinion of a doctor who can examine you-I cannot recommend therapy over the net. You can check the Cutera® website for doctors offering Laser Genesis® in your area.

For more information visit my Boston Plastic Surgery Practice, read Save Your Face or contact me.
Dr Seckel

Boston, Massachusetts

Peabody, Massachusetts

Take heart, there is newer technology that can help enlarged pores. LaserGenesis® a new product by Cutera® has been shown to reduce pore size as well as improve skin texture and reduce redness and fine lines. What I like best about LaserGenesis® is that unlike other lasers and IPL, there is no contact with the skin, thus it is safer and less likely to injure the skin during treatments. The laser beam is just passed over your face until you feel heat and then moved to another area. Treatments take about 20-30 minutes and cost $350 in my area. Since LaserGenesis® is a laser, it is much more powerful than LED.

PLEASE don’t overlook the importance of good skin care and skin exfoliation in reducing pore size and reducing oily skin! I always start my patients on a skin drying program before starting laser therapy.

The enlarged pores are large because the underlying oil gland is full of oil and stretched, and the stretched oil gland makes the pore-the opening of the oil gland to the skin surface larger. Thus if you reduce the amount of oil in the oil gland, the pore size will become smaller. Deep skin exfoliation with microdermabrasion and dernmasound and drying skin creams like Retin A and Brevoxyl washes are very helpful.

To accomplish this I start my patients on a skin exfoliation and skin-drying regime using Brevoxyl washes-you can find them at your drug store. Also microdermabrasion® and dermasound treatments can remove debris from the pores, open them up and let the oil out and once this has happened the pores will become smaller. Also there are prescription skin creams that can be very helpful. Differin® is a prescription topical gel which slows down the growth of the oil-producing cells in the oil glands. Retin A® and Tazorac® are also helpful in drying the skin and controlling break outs.

So, before you spend more money on laser treatments make sure you have optimized your skin care with a drying regimen and good skin exfoliation, deep cleansing, microdermabrasion and dermasound. Once the oil glands are producing less oil they will be smaller and a treatment like LaserGenesis® will be much more effective.You don’t want to have the laser treatment first and then have your oil glands working against you and ruin the result.

Good luck and take heart! People with oily skin may have larger pores but they don’t form as many wrinkles – so be happy about that!

For further information on facial rejuvenation visit my Boston Plastic surgery Website, read Save Your Face or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

Peabody, Massachusetts