Acne affects people of all ages and demographics and while there are many treatment options available many of them still leave patients with devastating acne scars. Steven F. Weiner, MD of Santa Rosa Beach, FL, has developed an approach to reduce and clear acne scars that has patients traveling from all over the world to smooth their skin and keep their complexions clear. In this interview with Aesthetic Insider™ Steven F. Weiner, MD, a Facial Plastic Surgeon and Head and Neck specialist who practices at The Aesthetic Clinique, discusses the use of new techniques and technologies that address acne scars in people of all ages and ethnicities. To learn more about Dr. Steven F. Weiner and his reJAWvenation technique, visit www.theclinique.com.
What is the most needed or popular technique you use to address acne scars?
We actually have four or five different techniques that we use to address acne scars and one of our more popular and effective approaches is called RF microneedling, which is radio frequency with microneedles.
How does RF Microneedling work?
The microneedles are insulated in a device where only the tips are exposed which causes energy to be delivered beneath the skin into the dermis and into the scars. The body reacts to that coagulation and results in a remodeling of the scars and more controlled formation of collagen and elastin, as well as hyaluronic acid which greatly improves scars. The coated needles protect the upper skin layer from the energy/heat, thus improving safety for darker skin types and decreasing downtime and wound care.
Do you ever use laser for acne scars?
The problem with lasers is that they damage the surface of the skin often causing an inflammatory process that in the darker skin types such as Asian, Hispanic and African-American, can result in darker pigmentation. As many of my acne scar patients are darker skinned individuals the risk of hyper-pigmentation is significantly high so I prefer the RF microneedling which I feel provides an even better result than a traditional blade or laser would. However, in lighter skin individuals, laser can be used in conjunction with RF Microneedling.
How did you get started using RF Microneedling?
I am a constant learner and have a keen interest in new technology. Approximately six years ago a new technology came out from Lutronic who are a leading company in aesthetic medicine. I do a lot of work with Lutronic and was eager to do research on the initial device called INFINI because the technology was unique – deliver RF energy deeply into the dermis while bypassing the more superficial layers. More recently Lutronic came out with a newer version called the Genius which combines Radio Frequency Microneedling with impedance monitoring. This gives more precise energy delivery and safer treatments. The research results were reported in various media outlets and as I had been part of the intitial research team. The publicity generated more and more acne scar patients to my practice from all over the world.
Do you use other methods to help patients with acne scars?
Great question. Yes. Not everyone needs just the Genius, some patients need extra treatment. Going back to the basics, there are 4 different types of acne scarring. Atrophic, ice pick, boxcar, and hypertrophic scarring. RF Microneedling does treat all these scars, however, adding other techniques can help these patients get a really nice result.
Ice Pick Scarring: Can also be treated with a TCA cross which is a trichloroacetic acid application much like what is used in chemical peels. Using a toothpick application, the TCA is placed precisely in the middle of the scar (generally a very deep hole in the skin) which causes a chemical peel within the middle of the scar and overtime, the body reacts by creating collagen so the depth and diameter of the scar decrease.
Atrophic Scarring: These are more wide based and often associated with volume loss. Frequently there is a tethering effect of scar bands from the skin down to the subcutaneous fat, and even the deeper fat areas. Subcision is used to break the scar tissue from the deeper layers using a blunt cannula (which I also use for the fillers), or some doctors prefer to use a Nokor needle, which is a needle that has a small widened end, almost like a knife. However, a knife can cause injury to blood vessels and nerves, and bruising is often a side effect, therefore my patients have preferred the blunt cannula approach. At the same time, I can also inject filler to the patients that have volume loss and the type of filler used depends on what the patient desires. I will often use Restylane Defyne® or Restylane® Refyne. I may also use Bellafill® which is FDA approved for acne scarring and gives a great, long term result.
Boxcar Scars: These can be the most difficult to treat and frequently I will do a TCA Cross in addition to the Genius. It’s a very complex process and many of these patients will routinely undergo a laser treatment too. In addition, we can either use PRP (Platelet Rich Plasma), amniotic growth factors, or topical creams. Lastly, we use a Healite which is a low level laser light and LED light that soothes the skin, expedites healing and decreases the redness associated with the procedure.
Do you also help patients control acne breakouts?
Many of my patients have acne as well as acne scarring and we have to treat the acne before we can begin an aggressive treatment for acne scars. At The Clinique we have a process to get the acne under control using almost exclusively lasers and topical skin therapy. We also use a vascular laser to offset the redness. In fact, we have three different lasers we use to control acne and the associated redness including the Excel V+ laser which is a 532 millisecond laser which attacks the acute acne and the pustules. As mentioned previously, lasers, topicals, FrozenC and the Healite are methods to reduce the bacteria and acne. We also use the Spectra by Lutronic, a 585 Q switch laser. This actually helps improve the early acne scars and destroy the acne bacteria. We also use the Aerolase 1064 laser which is a micro second laser and is great for cystic acne, and the microsecond pulse duration is ideal and very well tolerated.
Do you see a change in any changes in a patient after your acne scar treatment?
Most patients are very happy as they thought they would have to live with that depth of scarring forever. One patient in particular will always stay in my mind. He was in high school and had been battling severe cystic acne for several years. He wore his hair over his eyes and he just couldn’t get excited about anything. He couldn’t even look anyone straight in the eye because his acne and scarring was really terrible. I knew I could help but wasn’t sure just how much of the inflammation and scarring we could eradicate until we got the acne under control. As mentioned previously, lasers, topicals and the Healight are something we begin to reduce the topical bacteria and acne proliferation. With this particular patient, once we were able to get his acne under control and soothe and heal the tissue, we were then able to work on the many acne scars that covered his face. What was amazing to me was watching this young man go from a being a silent and depressed recluse, to a smiling, confident and much more outgoing person. Knowing I can bring a new level of confidence and happiness to a person like this, touches my heart.
Dr. Steven F. Weiner can be reached at 850-622-1214. To learn more about acne scar treatment, reJAWvenation and other aesthetic treatments offered by Dr. Weiner, www.theclinique.com
To listen to Dr. Weiner’s interview at Aesthetic Insider™ Radio, CLICK HERE