Acne & acne scars

Acne and its scars arise from distinct mechanisms, and it is from this distinction that my approach stems. In the active phase, it is an inflammatory process of the pilosebaceous follicle; once healing has taken place, coloured marks, described as post-inflammatory, or depressed or raised scars may persist. Because these situations, sometimes similar in appearance, do not arise from the same causes, they are not treated in the same way. The initial assessment is precisely what allows me to distinguish between them, to appraise the skin type and the phototype, and to discern what may fall within the scope of an aesthetic medicine procedure.

Depending on the case, management may draw on peels, laser or microneedling, used alone or combined within a personalised protocol. The peel rests on the application of medical exfoliating solutions; microneedling consists of fine breaches of the skin intended to stimulate the repair mechanisms of the dermis; the laser aims to act on the pigmentary component or on the scar relief, according to the type of device and the parameters selected. These techniques seek to improve the appearance of the skin, without, however, making it possible to prejudge the outcome, which remains specific to each situation.

The session takes place at the practice. The area is cleansed and prepared and, according to the technique selected, a topical anaesthetic may be offered; I favour parameters suited to the skin, reassessed from one session to the next. The face is the region most often concerned, without the back, the shoulders and the décolletage being excluded. The number of sessions, their spacing and the duration of each depend on the protocol and are specified to each patient in consultation; when an improvement occurs, it sets in gradually and in a measured way.

After-effects may occur: redness, a sensation of heat, transient swelling, flaking, or a temporary flare of lesions in the days that follow. A change in pigmentation remains possible, in particular on olive or dark skin, and requires sun avoidance and photoprotection, the terms of which are explained to each person. A prior consultation is mandatory: it allows the skin to be examined, contraindications to be looked for and each patient to be informed. Depending on the situation, active acne may first warrant medical treatment, and an aesthetic procedure may not be indicated.