About Face

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About Face

Chapter Four Acne Scarring Types of Scars Scar Treatments Dermabrasion Injections Dermal Punch Grafting Excision Face-lift

Injections

The use of injectable substances is the second method of testament for scarring left behind by acne. There are two kinds of substances commonly used: triamcinolone acetonide, known as Kenalog and a collagen implant called Zyplast. The Kenalog injection is a cortisone shot - a steroid. It works to dissolve solid scars, or what we call fibrocytes. Kenalog is a catabolic substance, meaning it interacts with the scar to break it down. A surgeon has to read the situation carefully before using Kenalog as it can be used in higher or lower strengths (for example, ten to forty milligrams per cc). The higher potency sometimes acts too efficiently and begins to break down the scar tissue too fast, so that you end up with a slight depression where the scar has collapsed. Kenalog is particularly effective when used on bumps or nodules caused by inflammation.

The second kind of injectable substance, the collagen implant called Zyplast, is a three-dimensional volume filler, meaning it will fill the width, depth and height of a hole in the skin. For most information on collagen, see the chapter on aging skin (Chapter Two). The idea is to fill a hole, or pit, so that the bottom of the pit is raised to become level with the surrounding skin. The most successful injections are those done in pits located in “nondynamic” areas of the face, that is, parts of the face that don’t move much. The injection wouldn’t last nearly as long in a pit located in a frown line or a laugh line; it might last as long as six moths at the outside edge of a cheek or on the chin. As I explained earlier, collagen is a biodegradable product, so it’s not a permanent solution. Nevertheless it results in a spectacular smoothing of the skin surface.

Even though it would seem the perfect solution, Zyplast does not work when applied to the ice pick scar. This is partly because an ice pick scar - being very deep and narrow - cannot be made less conspicuous by raising the depth of the scar or narrowing the opening at the surface. Often, too, an ice pick scar is very compacted, with more rigid walls than an ordinary acne pit. This means that the scar doesn’t yield at all when injected, and the Zyplast gets forced up through the centre of the pit.

Zyplast is best used on flat, shallow acne pits and areas where there is subcutaneous atrophy (a wasting away of fat under the skin). I often use it to temporarily augment surgical techniques like dermabrasion or dermal punch grafting. It’s a nice technique, for example, if a patient wants to look as good as possible for a photo portrait, or a wedding day.

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