Question: What are some techniques used for improving acne scarring?

Answer: There are multiple different techniques that can be employed to try to improve the appearance of acne scarring from as simple as filling the area with an injectable filler to subcision withs a needle in conjunction with some filler material to fat grafting or more aggressive treatments, such as laser resurfacing.  My personal gold standard at this time is actually a ProFractional Laser by Sciton, which is a fractionated Erbium laser where tunnels are vaporized into the skin and this creates a large amount of new collagen deposition into the dermis which in turn remodels the overlying epidermis and can create a very significant improvement in the appearance of acne scarring.  The downside is that I recommend three treatments spaced at least a month apart, so the overall downtime can be very significant since each treatment requires about four or five days where the skin is healing.  A very conservative approach, such as microdermabrasion or superficial or even medium-depth chemical peels, does very little for acne scarring and I recommend that patients avoid these techniques due to the fact that they are really not going to get any visible improvement in their acne scarring unless a more aggressive approach is undertaken. 

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Question: I really do not want to get a facelift yet. I am only 46 years old, but I do have some areas of concern on my face, and I would like some nonsurgical alternatives to repair them. For example, my skin has lost some of its elasticity and there is some sagging at my lower cheeks. Are there injectables that can be used as temporary stopgap measures?

Answer: Fillers can certainly be used to volumetrically enhance the face, which means adding volume can plump up the face and make the face look more youthful. Fillers can also be used to specifically fill wrinkles and depressions to add a more youthful appearance to the face as well. If you are looking at trying to improve laxity of the face in a nonsurgical way then you may want to consider Ultherapy, which is an ultrasound-based device that uses microfocused ultrasound to create new collagen deposition deep in the tissue of the face, which causes tightening and lifting. It is the only nonsurgical device ever to be given on lift indication by the FDA, and it is very consistent in the manner in which it delivers this energy. To treat the overlying skin, you may want to consider an in office ProFractional Laser treatment, microdermabrasions, and good physician-strength skin care.

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Question: Is microdermabrasion able to remove freckles, or are there any other procedures that would be more effective?

Answer: Microdermabrasion can certainly help people with the reduction or removal of their freckles, but additional treatments, including a good skin care with hydroquinone and excellent sun protection, would also be necessary and even then more than likely these procedures alone would not completely rid someone of their freckles.  In order to rid them of the freckles themselves, they would need to undergo a more aggressive treatment such as a laser resurfacing, though simply for freckle reduction they would not necessarily have to go horribly deep with the laser resurfacing, but in the future they would have to provide excellent sun protection for their skin or the freckles will definitely return.

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Question: What condition does microdermabrasion improve?

Answer: The most significant condition that microdermabrasion improves is the dull complexion of the skin. Essentially as we age, or due to sun damage, the dead layer of skin at the surface called the stratum corneum tends to hang on to the skin giving it a very dull, slightly rough appearance. Microdermabrasion takes off this dead, dull layer revealing the brighter, more youthful underlying skin that creates a better reflection of light off the surface. Microdermabrasion also allows skin care products to penetrate better and to be more effective. It further stimulates the skin with increased vascularity and can even improve some of the collagen of the skin and improve some of the very fine lines as well. 

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Question: What is microdermabrasion?

Answer: Microdermabrasion is any treatment that abrades the superficial layer of the skin and historically these were performed with crystals that were essentially blown at the face, almost like a miniature sandblasting effect. Today it is much more common to see devices that do not use particles but rather use diamonds embedded in a wand that is also placed under suction and this is then passed across the face taking off the superficial layer of the skin. This is done relatively gently and ends up creating only a small amount of pinkness to the skin, but overall this buffing effect gives a nice polishing to the skin and overall improves the quality and appearance of the skin, especially the light reflection of the skin. This also allows skin care products to penetrate better and when microdermabrasion is performed on a regular basis it can certainly be a very important part of an overall skin care regimen.

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