Acne is a common disorder of the skin that originates from the pilosebaceous unit. It consists of blackheads, papules, pustules, and in severe cases, nodules and lumps are also involved. Usually caused by hormonal changes and or psychological distress.
The main treatment option for acne is medical therapy. While acne surgery, in some cases considered as an additional option. The surgery is only performed by a trained dermatologist using various techniques, such as dermabrasion, cryotherapy, and laser resurfacing.
Acne Surgery Purpose
Acne surgery is recommended as a treatment for active acne and acne scars. To treat active acne, surgery is performed as an adjunctive therapy especially in severe or complex cases where medical therapy is ineffective. The purpose of this procedure is to treat active acne and ensure the skin is healed properly and completely, regardless of any cause.
Acne surgery can also be performed to improve the appearance and remove any kind of acne scars, such as:
- Macular-erythematous scars
- Scars or pockmarks – This is a sharp, deep scar, usually with a wide surface and narrow bottom.
- Wavy scar tissue – A collection of scar tissue that looks like a wave.
- Boxcar Wash – This is a large round and wide scar between the surface and essentially the same, therefore looks like a crater.
- Elevated Hypertrophic scars – These scars may have keloids or papules.
- Bridge scar – These are some of the linear scars that are connected because of the epithelial tract. Usually contains sebum and has a foul odour.
The goal of acne surgery to treat scars is to make it less visible and improve the patient’s facial appearance.
Acne Surgery Method
There are several techniques used in acne surgery based on the severity of the condition. Acne is actually also classified into levels, namely:
Acne Level 1
At this level, most acne is caused by blackheads so it can be overcome by:
- Extraction of blackheads – This is a process of applying simple mechanical pressure on acne to remove blackheads or contents that clog the pilosebaceous follicles that cause the growth of acne.
- Chemical peel – This is a surface treatment that involves the application of a chemical fluid that can destroy the epidermis in a controlled manner. As a result, tissues that experience acne or scars can be peeled off. Exfoliating fluid usually contains salicylic acid with concentration 20 – 30%, glycolic acid with concentration 20 – 35%, and trichloroacetic acid with concentration 10 – 15%. Sometimes, there is a special liquid called Jessner’s, made of resorcinol, salicylic acid, lactic acid, and ethanol.
Acne Levels 2 and 3
This refers to acne that develops due to inflammation of papules and pustules. This condition can be overcome by:
- Cryotherapy – Usually used to treat nodulocystic acne, this technique uses cryolush and cryopeel. In treatment with cryolush, a paste made from solid carbon dioxide that has been crushed and mixed with acetone is applied to acne lesions for 2 – 10 seconds. This treatment will cause necrosis that triggers exfoliation on the surface of the skin. While in cryopeel treatment, liquid nitrogen is sprayed on the target area for 2 – 3 seconds.
- Laser therapy and non-ablative light – Laser and light therapy techniques that are effectively used in acne surgery are very diverse, including:
- Blue light therapy
- Non-ablative radiofrequency
- Nd: YAG laser
- IPL or Intense Pulsed Light
- PDT or Photodynamic therapy
Acne Level 4
This is a nodulocystic acne, or that consists of nodules and lumps. This condition can be overcome by:
- Intralesi corticosteroid – This treatment is usually used to treat keloidal acne scars, using triamcinolone injection to reduce inflammation and cause rapid involution of acne.
- Subcision – This treatment is more commonly used in acute wavy acne scar tissue, working to release the fibrotic strands attached to the scars in the subcutaneous tissues.
- Punch excision/removal/grafting – This is recommended for deep scars or pockmarks and boxcar. Pockmarks can be overcome with punch excision, but patients need additional treatment that is in the form of fillers.
- Incision / dry bump – If there is a lump in the acne, then the lump should be removed and dried so that the skin can recover. This is considered the most rapid way to remove cystic lesions but also minimizes scarring. The lump is dried with an incision made using a scalpel number 15 and the lump wall will be autopsied with 88% phenol. After that, neutralized using povidone-iodine.
The right treatment depends on the level of acne suffered by the patient. In some cases, patients require more than one type of therapy.
Possible Complications and Risks of Acne Surgery
Acne surgery can cause several complications, including:
- Prolonged erythema
- Post-inflammatory hyperpigmentation
- Postoperative scarring, which may require other operations
Scarring and hyperpigmentation usually appear in patients who have dark skin tone. Patients with basic medical conditions, such as active herpes simplex and immune-suppressive conditions will experience a slower post-operative healing period. Doctors need to use appropriate techniques that suit the type of acne to reduce the risk of post-acne surgery scar.