Have You Fought and Lost the Battle
Against Acne? You May Be Able to Win the
War: Acne Scars Effaced
For years, the blight of
acne scars has plagued millions. Until
now, people who suffered from moderate
to severe acne could expect to wear their
badges of combat from the acne wars on
their face. However, thanks to the latest
surgical advances, veterans of the war
against acne may now claim some victory.
Dr. Michael Eisemann, a Houston board-certified
plastic surgeon, performs several old
and new surgical procedures that often
significantly improve acne related scars.
Combining the use of dermabrasion, laser
resurfacing and the “punch-excision
skin-grafting technique”, patients
with acne scars can expect at least a
50% improvement to their skin.
Dr. Eisemann defines acne
as, “the bacterial colonization
of hair follicles and the sweat gland
units”. The results of this condition
are pimples and in some cases, a severe
problem of scarring if not properly treated.
The acute acne patient is treated with
topical and systemic antibiotics, Retin-A
and Acutane. Dr. Eisemann says, “Retin-A
inhibits the formation of black heads
and comedones (pimples or cysts under
the kin) by causing the sloughing of the
horny cell layer by r\preventing the cells
from sticking together and blocking pores.
Retin-A is very effective in treating
the earlier stages of acne. However, the
development of cystic acne requires Acutane,
an orally consumed medication that suppresses
the oil content to the sebaceous glands
and follicle cell epithelial growth. For
patients taking Acutane, it is critical
to avoid sun exposure. Hopefully Retin-A
and Acutane will control acne effectively
enough to prevent visible pockmarks and
scarred skin. In some cases, acne scars
or blemishes may be inevitable.
Before Dr. Eisemann is ready
to surgically restore a patient’s
skin, he first decides who is an appropriate
candidate. According to Dr. Eisemann,
“first and foremost, the patient’s
acne condition must be stabilized by a
dermatologist. The acne must be in a chronic
stage, not active or inflamed, before
I even consider surgery. In addition,
a patient on Acutane must wait at least
one year following treatment before having
any form of surgical treatment such as
dermabrasion, laser resurfacing or chemical
peels which all create a controlled wound.
Acutane delays the formation of new skin
by delaying reepithelialization. Various
medications are used to pre-condition
the skin before surgery, such as bleaching
agents (hydroquinones) and steroids to
prevent post-inflammatory hyperpigmentation
and Retin-A to speed reepithelialization
in forming a new skin layer. Immediately
before the actual procedure, Dr. Eisemann
numbs the area with the injection of local
anesthetics (Xylocaine) and applies topical
EMLA cream.
Depending on the severity
of the “skin craters”, Dr.
Eisemann will use a progressive combination
of three different procedures and says,
“Dermabrasion is a leveling form
of therapy that uses small chips of diamond
attached to a stainless steel wheel. The
wheel is rotated by a high speed motor
and brushes the upper layer of the skin
which includes the intermediate layer
of the dermis.” If the doctor does
not go through the complete layer of the
dermis, one can expect complete healing.
Otherwise, going “too deep”
can result in scars. “Using dermabrasion
is really an art form”, Dr. Eisemann
says, “but for deeper skin blemishes
I prefer using the ultra-resurfacing laser
because controlling the depth is easier
and there is always a critical level I
want to reach but not exceed.” Ultra
short bursts of laser energy are applied
to the skin so it is not irreparably burned.
A new firm layer of collagen forms in
the dermis that tightens the skin making
acne scarring less noticeable.
Dr. Eisemann feels that
in many cases, more than one procedure
may be necessary and says, “Repeat
procedures may be safer than trying to
‘go for broke’ the first time.
Dermabrasion or lasers are very effective
for treating shallow craters, but for
deep ‘ice-pick’ scars, neither
the laser nor dermabrasion will be effective.”
In those instances, Dr. Eisemann says,
“the most appropriate treatment
entails small punch-excisions and skin-grafting
which encompass the ‘ice-pick’
craters going down the subcutaneous tissue.
A one to three millimeter skin graft is
taken from behind the ear with a sharp
punch whose diameter is ½ millimeter
larger than the punched out crater removed
from the cheek. The doctor then transplants
the grafted skin to the recipient cheek
skin.”
Whether Dr. Eisemann
performs dermabrasion, laser resurfacing
or the “punch-excision” grafting
technique, the healing time from such
procedures is substantial. “These
procedures are controlled wounds”,
Dr. Eisemann says, “It takes ten
to twelve days before the skin re-grows
and heals. There are long periods of redness.
A camouflage makeup is used to disguise
the red areas with a green base makeup.
The patient may further add “toners”
as color is slowly restored. All of the
postoperative camouflage makeup and healing
instructions are provided by Dr. Eisemann.
After years of long, hard-fought battle
against acne, today’s surgical advances
have claimed significant victories.
For information or a consultation with
Dr. Michael Eisemann, director of the
Cosmetic DaySurgery Center, call (866) 731-3198 or visit our website at www.cosmeticsurgeryhouston.com.
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