Acne is a common skin disorder that originates from the pilosebaceous unit. It is made up of comedones, papules, pustules, and in severe cases, nodules and cysts. It is commonly caused by adolescence, hormonal changes, and psychosocial stress and is the most common cause of facial scarring.
The primary treatment option for acne is medical therapy with surgery being considered as an adjuvant therapy in some cases. The procedure is performed by trained dermatologists with the use of different techniques, including dermabrasion, cryotherapy, and laser resurfacing, among others.
Acne surgery can be recommended for the treatment of active acne and post-acne scarring.
For the treatment of active acne, surgery is performed as an adjunct therapy, especially in severe or complicated cases wherein medical therapy is insufficient or ineffective. The goal is to treat active acne and ensure that the skin heals properly and completely, regardless of its cause.
Acne surgery can also be used to improve the appearance and completely resolve all kinds of acne scars, including:
The goal of acne surgery for the treatment of post-acne scars is to make the scars less visible and improve the overall cosmetic appearance of the patient’s face.
There are several techniques used in acne surgery based on the severity of the condition. Acne is generally classified into four different grades of severity, namely:
Grade 1 acne – This refers to acne that is predominantly comedonal and can thus be treated with:
Grade 2 and Grade 3 acne – This refers to acne that is predominantly made up of inflammatory papules and pustules. These can be treated with:
Grade 4 acne – This refers to nodulo-cystic acne, or those that contain nodules or cysts. These can be treated through:
Intralesional corticosteroids – Used primarily for the treatment of keloidal acne scars, this takes advantage of triamcinolone injections to reduce inflammation and cause rapid involution of the acne.
Subcision – This treatment, which is used primarily for rolling scars, works by breaking down the fibrotic strands that attach the scar to the subcutaneous tissue.
Punch excision/elevation/grafting – This is great for depressed scars and boxcar scars. Depressed scars that have been treated with punch excision may also sometimes require a secondary treatment in the form of fillers.
Incision/drainage of cysts – If acne has a cyst inside it, the cyst has to be removed and drained for the skin to heal. This is considered the fastest way to resolve cystic lesions while also minimising scarring. The cysts are drained through a fine incision made with a no. 15 surgical blade and its walls are cauterised with 88% phenol then neutralised with povidone-iodine.
The appropriate treatment to use depends on the type of acne the patient has. In some cases, patients require more than one type of therapy.
Acne surgery can cause some complications, which may include:
Scarring and hyperpigmentation more commonly occur among patients with darker skin.
Patients with existing medical conditions, such as active herpes simplex and immunosuppressive conditions, may also experience delayed healing after the surgery. This is why patient selection is of utmost importance. Also, to reduce the risk of post-operative scarring, the use of the appropriate surgical technique that corresponds to the type of acne involved is important.
Khunger N. “Standard guidelines of care for acne surgery.” Indian Journal of Dermatology, Venereology, and Leprology. 2008; 74(7): 28-36. http://www.ijdvl.com/article.asp?issn=0378-6323;year=2008;volume=74;issue=7;spage=28;epage=36;aulast=Khunger
Fabbrocini G, Annunziata MC, et al. “Acne scars: Pathogenesis, classification and treatment.” Dermatol Res Pract. 2010; 2010:893080. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2958495/