Instead of re-surfacing the surrounding areas, doctors are now looking at numerous substances that can act as fillers to address acne scars caused by acne. While many chemical fillers have been proposed, there is currently only one that has been approved by the FDA, and evidence remains inconclusive.
Acne has been the scourge of many a prom or grad pictures, but its consequences go well beyond the hormonal surges of adolescence. Left untreated, acne can result in a condition called acne vulgaris that affects up to 8 out of ten adolescents and in most cases, results in some form of scarring. This happens when the damage caused by the infection goes deep into the dermal layers of the skin, well beyond the regenerative capacities found in the outlying epidermis. Dermatologists use descriptive terms for these atrophic scars that are visually accurate – pock-mark, icepick, rolling, and box-car scars. The psychological impact of facial scarring can persist well into adulthood.
Dermatologists traditionally treat the scarring by smoothing out the edges to make the scars less noticeable. The approach is to reduce the surface irregularities by thinning out the areas surrounding the scar. Techniques like mechanical dermabrasion, chemical peels, or laser resurfacing use this principle to create a more even surface. The obvious downside is that one can only go so far in attempting to even things out; there is a limit to the amount of resurfacing that can be done without causing injury to the skin and some scars run too deep for this method to be effective.
Because of this inherent limitation, doctors are now looking at re-volumization, which essentially means filling in these scar defects. A number of fillers are already used in augmenting soft-tissue defects in the face; dermatologists are now looking at these to address acne-related defects. These proposed substances range from those naturally occurring in the body (Hyaluronic acid) to the synthetic acrylic (poly-methyl methacrylate or PMMA) or silicone. A journal article titled “The Role of Fillers in the Management of Acne Scars” reviews how these available substances have been used in different trials and their relative efficacy. The findings report that only PMMA is currently approved by the FDA for acne scars (and in limited applications, to boot). Furthermore, the evidence for other fillers in remains equivocal at best.
The challenge in replacing volume is finding the right substance to act as a filler. Not only should it be able to replace the lost volume, but it should be as biologically inert as possible: the chemical formulation should resist the body’s attempt to break it down or absorb it without triggering a reaction or an outright infection. Presently, no one substance fulfills that criterion; and in lieu of finding that ideal filler, using currently available PMMA in conjunction with resurfacing techniques may hold more promise for filling up those small imperfections.
Written By: Jay Martin, M.D.