Fillers for acne scars is not new, however over the past year has been revolutionised by newer, safer, and longer lasting fillers. Historically, dermal grafts were used as fillers. This involved taking your own dermis from behind the ear, resurfacing the top layer to remove the dermis, trimming down the fat, and harvesting strips of collagen. This was then broken down into filler fillets and placed under the skin.
The use of newer HA fillers has taken off in the past 2-3 years. HA fillers have largely replaced dermal grafting in the treatment of acne scars, as they are far safer, and more convenient for the patient, with little or no downtime needed.
Certain scar types improve more than others- these include atrophic and rolling scars, as ‘loss collagen’ can be filled. I often use two different types of fillers for this, including the use of a thick filler for volume loss and rolling scars, and a thinner more fluid filler for more superficial scars. Layering of a HA based filler gives the best outcomes- results are instant. Most acne scar fillers last between 6-18 months, depending on the type of filler we use.
In many cases I often combine laser with fillers, this has logic as laser scar revision is permanent whilst fillers are temporary. Lasers stimulate your own natural body to produce collagen, and this is YOUR COLLAGEN to keep. Once I get to the point whereby no more collagen can be generated, I use fillers to ‘fill in the gaps.’’ This has both advantages and disadvantages- namely laser procedure usually has a ‘downtime of 8 -10days, coupled with the expense of laser therapy for acne scars. The flipside? Much less filler needs to be used, and scars such as superficial box car scars will disappear completely with laser therapy.
This is an example where I used layered fillers- a thick filler to increase volume - this typically last 2 years, followed by a superficial filler to layer finer scars.
Acne scar revision is that delicate balance between permanent vs temporary, downtime vs recovery, immediate vs intermediate, and costs. Finding the correct balance for every individual and THEIR scar type is the key.
Dr Davin S. Lim