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Acne Scarring

Acne vulgaris, or cystic acne, is a common but extremely difficult problem. For some patients, topical or even oral antibiotics are required, and in persistent cases, special medications such as Accutane (isotretinoin) may be prescribed. Though the pustules, comedones, and cysts are most prevalent in adolescence and the teen years, significant and even disfiguring scars may remain for years after routine breakouts have stopped. This can cause serious emotional distress, and serves as a constant reminder of those difficult times.

Fortunately, there are treatments for acne scarring. The deepest scars, sometimes referred to as “ice pick” scarring because of the deep, pinpoint holes in the skin surface, may be treated with meticulous excision (removal). Dr. Ransom uses special instruments that are only 1 or 2 millimeters in size to remove the scarred areas, and closes the defects with tiny, hair-thin sutures. Once the deepest scars have been removed and the skin is healed, he then performs dermabrasion, laser resurfacing, or a chemical peel to even the skin surface and promote healthy skin growth. As the skin heals from the inside out, new collagen is formed and a more even color and texture become apparent.

Dermabrasion must not be confused with microdermabrasion, which is a minimally invasive (and less effective) treatment offered at salons and spas, and is not typically administered by a medical professional. Dermabrasion is a surgical procedure which is performed by a doctor, and involves removal of the outer layer of the skin (epidermis) and a portion of the deeper layer of the skin (dermis). It is used to treat many different types of scars (for example, from soft tissue trauma or previous surgery), and deep wrinkles (particularly around the mouth).

Non-surgical options may be preferable for some patients and offer excellent results in many cases. This includes radiofrequency microneedling with the INFINI™ device. This technology combines the benefits radiofrequency energy – which can deliver heat to deepest layers of the skin without risk of scarring or pigmentation change – with microneedling that is clinically proven to stimulate collagen growth. For persistent scars or skin surface irregularities, Dr. Ransom also uses Bellafill®, a two-in-one filler that promotes remodeling of the skin where it is injected. Bellafill® contains bovine collagen, which works as a temporary soft tissue filler, and polymethyl methacrylate (PMMA), which is a potent stimulator of the body’s own collagen production. Native collagen is made as the injected collagen is slowly absorbed, with significant long-term improvement in tone and texture of the treated areas – up to 5 years!

Using the latest in aesthetic medical treatments before and after your procedure, Dr. Ransom makes sure that your skin heels quickly, with an even color, improved texture, and smooth contour. By personally administering your resurfacing procedure, Dr. Ransom ensures that you achieve the best result in the most comfortable and convenient way possible – and with the quickest recovery.

Who is a candidate?
Anyone with deep scarring or skin texture irregularities from acne can undergo treatment. However, the exact method and timing of the treatment will differ between patients, based on the degree of scarring, areas involved, overall skin health, and other factors. Treatment of acne scarring is undertaken after the acne has resolved. For younger patients (teenage to early 20’s) or those with ongoing outbreaks, treatment may need to be delayed; in these cases, Dr. Ransom focuses on medical treatments and minimally invasive procedures. Finally, skin resurfacing procedures may be contraindicated in patients with certain rare skin and connective tissue disorders, or those who have undergone radiation therapy to the affected areas. For patients who have used Accutane (isotretinoin), special consideration is given to the type and timing of scar treatments. Most patients are suitable for INFINI™ treatment, regardless of skin type or color. Bellafill® cannot be administered to patients with an allergy to bovine collagen; luckily, this is quite rare.

Frequently Asked Questions

Q: What causes acne scars?
A: During the active phase of acne, significant inflammation occurs in the skin. The body uses inflammatory cells (white blood cells) to help fight infection, but unfortunately, this process can cause collateral damage. As a side effect of inflammation, changes can occur in the pigmentation (color), texture, and surface contour of areas affected by acne. This is particularly true where the acne has been cystic (pockets of fluid or pus). In these cases, the area where the skin has been damaged is not always replaced with normal skin. It may instead be replaced with scar tissue – causing a visible and palpable difference in the skin, or not heal at all – leaving a pinpoint hole (“ice pick”) or flat area (“boxcar”).

Q: How much improvement can I expect?
A: With “ice pick” scars, the deep holes are removed completely and the skin surface is dramatically improved. With larger areas of diffuse scarring (so called “rolling” scars), a significant improvement can be achieved. Complete resolution, however, is often not possible, and patients should not expect to have no evidence of scarring. With a carefully planned and executed treatment plan, including scar revision, resurfacing, and medical management, skin color, texture, and overall appearance will be greatly improved.

Q: What is the recovery like after treatment of acne scarring?
A: Depending on the method used, recovery can be a couple days to a week or more. For excision of “ice pick” scars, sutures are left in place for about five days and recovery is very quick. Bellafill® treatment may cause slight irritation at the injection site, but otherwise does not require significant downtime. With skin resurfacing and INFINI™, there is an initial healing phase that lasts about a week. This is followed by a gradual repair of the skin from the inside out, with improvements in skin color and texture over a few weeks. Dermabrasion and laser resurfacing require an occlusive dressing or thick ointment to be worn over the treated areas. Pain is minimal, though the skin will be sensitive to ultraviolet rays (UV), so patients must avoid direct sun exposure during healing.

Please note that all patients are different and individual healing times and results may vary. The statements regarding procedures and recovery made here are general rules.

5.0

Based on 19 reviews

Christina G.
I had several nasal/sinus issues including a severely deviated septum and a dorsal hump, which I wasn't crazy about. Dr Ransom did both the medical and aesthetic parts of my surgery and he did a wonderful job! While I did have some swelling, I didn't experience much bruising at all. I loved that he left the natural look of my nose just making small corrections. My breathing has GREATLY improved. His office staff was super helpful in scheduling and making sure payment and everything was very clear. I am very, very, very pleased with my results!!
Tk I.
I had a terrible surf accident in Bali and needed to get 50 stitches to repair what the reef did to my face. I had emergency cosmetic surgery in Bali the day of the accident. Immediately when i got back to the states i was introduced to Dr Ransom through some mutual friends. I was searching for the best cosmetic surgeon in San Francisco to help in my recovery. He and his team have been amazing! he helped establish a plan for my post-op wound care/treatment and administered some initial laser treatments. Dr Ransom and his team are extremely knowledgeable and very patient / helpful. I am very grateful for their help and support. I am finally looking normal again!
Joey B.
I had three issues with my nose - which inhibited my breathing: 1- broken nose, 2 - narrow nostrils that collapsed when I inhaled through my nose, 3 - deviated septum. When I was living in New York, I went to see a doctor about my breathing issues, and he said my skin was too thin and there was likely nothing he could do to rectify the problem. Dr. Ransom was recommended by an ENT I saw through One Medical. As soon as he saw him, he said he could easily fix my nose, and remove the bump that had formed from the trauma. His confidence and strong sense of self immediately put me at ease, and I had little doubt that he could accomplish exactly what he promised. He showed me a modified picture of my nose , and really liked what he proposed. The end result very closely matched what he promised. Not only can I now breath much more easily through my nose, it looks much better. He managed to make it look like an improved version of itself, however I still look like me, and unless I tell anyone I had it done, it's not overly noticeable, which I prefer. I'm pretty vain and very critical, and I can say that Dr. Ransom is great, and comes highly recommended.
Edward T.
Doctor Evan Ransom took my surgery on relatively short order and did a wonderful job. He is very talented and has a nice friendly professional support staff. I can not thank him enough, he was calm, caring, professional and interested in the follow results of his work . He seemed to bring a certain artistry to the profession.
Lisa C.
Dr. Ransom is a talented physician. He is knowledgeable, professional and goes the extra mile to make you feel comfortable during your treatments. He has been blessed with an artistic eye which brings wonderful results. I highly recommend Dr. Ransom and would refer all of my friends and family members to choose him as their physician.
Cheryl H.
Dr Ransom is very kind, honest, and conscience doctor. I was referred by my best friend, she is also Doctor Ransom patient. She has so much good things said about Doctor Ransom. So I had a face lift done by Doctor Ransom on July 2015. He did a wonderful job on my face and I have a lot of compliments on my face. So if anyone want to get their face done. I would highly recommended Doctor Ransom to you. I give Doctor Ransom a five stars.
Jill P.
I have currently been getting botox regularly with Dr. Ransom and he does a fantastic job. My previous doctor's office moved to another location where it was no longer convenient. I didn't realize what I was missing until I went to Dr. Ransom. I felt really comfortable, but most important he did a terrific job blowing my previous doctor out of the park. (Sometimes it's good switch it up a bit to make sure you are getting the best treatment.) On top of that, Dee the office manager is an incredible asset to the office. She personalizes your visit and relationship with the office to an extent I have never experienced before. I even get follow up calls to see how I am doing after a treatment. I highly recommend Dr. Ransom for his great work, and his team's impeccable customer service.
Arielle C.
Dr. Ransom and Dee are the BEST! Whether it's aesthetic or reconstructive, I'd trust him over and over again with my face.