"My acne scars just won't fade..." The reason may be that your skin type and your treatment simply don't match.
- The optimal treatment for each type of acne scar (redness, pigmentation, craters)
- A thorough comparison of Dermapen, CO2 laser, and RF microneedling
- An evidence-based guide to choosing an "effective treatment" by type
"Every time I look in the mirror, the bumpy scars and redness get me down..."
"I've tried expensive cosmetics and clinic treatments, but my skin still won't reach the ideal I'm after"
Quite a few women in their 20s to 40s carry these worries. In fact, the "right" treatment for acne scars differs depending on their type and depth. Sometimes a treatment you keep up thinking it's good for you is actually taking the long way around.
Overturning the conventional wisdom of acne scar treatment? Why Dermapen alone can't fix every bit of unevenness
Many people probably think, "When it comes to acne scars, Dermapen comes first." Dermapen is indeed an excellent treatment, butit is not the case that "just doing this will make any acne scar clear."Here lies a trap that many people tend to fall into.
Microneedling, such as Dermapen, is a treatment that uses fine needles to create countless tiny holes in the skin, harnessing the skin's own natural healing power to promote collagen production. In technical terms it is called "percutaneous collagen induction (PCI)," and its hallmark is promoting reconstruction of the dermal layer without significantly damaging the epidermis [1].
Because the downtime (the period until post-treatment redness and so on subside) is relatively short and the risk of pigmentation (PIH) that tends to occur with laser treatment is low, it is regarded as a safe treatment well suited to the skin of people of color, including the Japanese [2].
In fact, in a study of patients, three months of treatment (six sessions every two weeks) produced a 51-60% improvement in appearance and a 40-50% improvement in skin texture, with high patient satisfaction of 80-85% [3]. Skin biopsies also proved a significant increase in type I, III, and VII collagen [4].
However, there are in fact acne scars that microneedling is good at and acne scars that it is not. According to the published data, it is effective for the rolling type (shallow, wave-like depressions) and the boxcar type (depressions with vertical edges), but it is known to be less effective for the icepick type (point-like deep craters) [5].
In other words, repeating Dermapen alone on deep icepick-type scars may not bring about as much change as expected. So which treatment should you apply to your own acne scars? We will explain in detail next.
Which type are your acne scars? A comparison of the optimal treatment approach that changes by type
The greatest key to a successful acne scar treatment is"correctly knowing the type of your own acne scars."Acne scars are broadly classified into three kinds: redness, pigmentation, and unevenness (craters). It is extremely important to choose the optimal treatment for each condition.
- Acne scars with redness:A state in which prolonged inflammation has dilated the capillaries, so that the blood shows through.
- Pigmentation (spots):A state in which acne inflammation has overproduced melanin, which has deposited in the skin and remains as a brown mark.
- Unevenness / craters:A state in which inflammation has reached the deep dermal layer, destroying normal collagen tissue so that the skin caves in.
For example, craters (atrophic scars) are further classified into three types by their shape. The first is the "boxcar type," with a wide opening and a flat bottom. The second is the "rolling type," with gently undulating, wave-like depressions. The third is the "icepick type," deep, sharp, point-like marks as if pricked with an icepick [6][7].
For redness and pigmentation, chemical peeling that promotes skin turnover, orpeelingand mild laser treatments that respond to melanin and capillaries are often effective. However, in the case of craters where the dermal tissue has been destroyed, caring for the skin's surface alone will not heal them.
To smooth out cratered skin, a powerful treatment that forcibly rebuilds collagen from deep within the skin (Dermapen, CO2 laser, RF microneedling, etc.) is required. Furthermore, you need to determine which device to use according to the depth and shape of the craters.
An astonishing 85.4% improvement rate! The power of combining Dermapen with other ingredients
If your acne scars turned out to be a type suited to Dermapen (microneedling), there is also a way to dramatically enhance its effect: "combination treatment" with active ingredients. It can regenerate the skin far more efficiently than treatment performed on its own.
The latest research has made clear that combining Dermapen with ingredients such asPRP (platelet-rich plasma)yields a higher effect than performing Dermapen alone. PRP is a component extracted from the patient's own blood, rich in growth factors that accelerate cell repair. Performing Dermapen while letting it penetrate the skin promotes powerful wound healing [8].
Let us introduce data from an actual study of 41 patients. After four treatments at one-month intervals,on the side of the face treated with Dermapen plus PRP, improvement of acne scars was observed in 85.4% of patients[9][10]. Also, when Dermapen was combined with non-cross-linked hyaluronic acid (a moisturizing, anti-inflammatory ingredient), a high improvement rate of 82.9% was reported [11].
In a separate evaluation comparing patient satisfaction, the group that combined the two showed significantly higher satisfaction and greater reduction of acne scars than Dermapen alone or PRP injection alone [12][13]. Dermapen also functions as a "road builder" that delivers growth factors, hyaluronic acid, and the like deep into the skin, boosting to the maximum the effect of smoothing cratered skin.
Furthermore, beyond PRP, studies have also been conducted combining Dermapen with whitening and anti-inflammatory ingredients such as vitamin C. High satisfaction was obtained when vitamin C was combined as well, making it very effective for people who have both acne scars and pigmentation (spots) mixed together [14].
CO2 laser versus RF microneedling: the comparison and best option for stubborn cratered skin?
So how should we deal with "deep craters (icepick type)" that are hard to improve with Dermapen, and severe unevenness that needs more powerful treatment? Here we want to compare and consider"CO2 laser" and "RF microneedling"—these are the two approaches.
Fractional CO2 laseris a powerful "ablative (shaving/vaporizing the skin surface)" type of treatment. It irradiates the skin with a microscopic laser and shaves off the skin in points using thermal energy. Because powerful heat reaches deep into the dermis, it strongly promotes collagen production and demonstrates a very high effect on improving deep unevenness [15].
While the effect is high, there are also drawbacks. Because it shaves off the surface skin, the downtime is long, with conspicuous redness and scabbing lasting from a few days to about a week. Also, in people of color (including the Japanese), the risk of post-treatment pigmentation (PIH) due to heat damage is somewhat higher, which requires caution [16].
On the other hand,RF microneedlingis a treatment that inserts ultra-fine needles into the skin and irradiates the dermal layer directly with RF (radiofrequency) (radiofrequency) thermal energy from the needle tips. It enables a "non-ablative" approach that strongly tightens only the deep skin and promotes collagen production while keeping thermal damage to the surface skin (epidermis) to a minimum [17].
Studies on RF microneedling have confirmed that, while it has an effect equal to or greater than fractional laser, the risk of post-treatment pigmentation is lower and pain and redness subside faster (shorter downtime) [17]. One study of aged skin also found that, compared with ordinary microneedling, RF microneedling reduced senescent cells more and increased collagen content more [18].
In other words,if you "can tolerate a longer downtime and just want to powerfully treat deep unevenness," choose the CO2 laser,if you "want to treat deep unevenness thoroughly while keeping the pigmentation risk down and without affecting your work or daily life," choose RF microneedling—such a choice can be said to be one best option.
What is the "fail-proof" way to choose acne scar treatment, as proven by published data?
So far we have compared the three treatments of Dermapen, CO2 laser, and RF microneedling. In fact, to absolutely avoid failure when choosing a treatment, there is one thing you need to take into account. What is it?
The answer is the idea of"combining multiple treatments (a multimodality approach)."As the earlier research data showed, it is extremely difficult to achieve a perfect result with "just one treatment" in acne scar treatment [19][20].
For example, the most effective approach is customization, such as performing short-downtime Dermapen or RF microneedling on the whole face, and combining pinpoint TCA peeling (peeling using high-concentration acid) or CO2 laser only on particularly deep icepick-type craters [2].
Also, in the case of severe acne scars, fibrous tissue beneath the skin may have adhered and be pulling the surface down strongly. In such cases, combining "subcision (a treatment that physically severs the adhesions beneath the skin with a medical needle)" in addition to laser or RF microneedling makes it easier for the depression to plump up [21].
Treatment intervals and the number of sessions also matter. Many clinical trials have shown that acne scar treatment achieves a visible, major improvement by"repeating at least 4 to 6 sessions at intervals of 3 to 4 weeks."[22][23][24]. Continuing treatment methodically, without rushing and in step with the skin's turnover, is the shortest route to ideal skin.
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Summary of this article
- Identify the type of acne scar:They are divided into redness, pigmentation, and unevenness (craters), and the optimal treatment further differs by the shape of the crater.
- The true value of Dermapen:Effective for shallow to moderate unevenness. Combining it with PRP (platelet-rich plasma) and the like can be expected to give a high improvement rate of 85.4%.
- Comparison for deep craters:If you seek a powerful effect, "CO2 laser" is recommended; if you want to act on the deep layers while keeping pigmentation risk and downtime down, "RF microneedling" is recommended.
- The optimal treatment is a combination:"Customization" that combines multiple treatments to match your skin condition and tolerance for downtime is the key to success.
Even acne scars that have troubled you for years can, with the latest medical technology and the right approach, very much be improved into smooth, beautiful skin. The best treatment changes depending on your own skin condition and the type of your acne scars.
Rather than judging for yourself based on internet information alone that "this treatment must be good," the first step is to first have a specialist physician correctly diagnose the condition of your skin. At Zetith Beauty Clinic, we propose an optimal customized treatment plan tailored to each patient's acne scar depth and lifestyle. Please feel free to consult us first.