Thursday, October 21, 2021

Efficacy, Before and Afters, Cost and More

  • Fillers are gel-like natural or synthetic substances used to smooth lines and restore lost volume
  • Fillers can also effectively reduce the appearance of some types of acne scars
  • There are multiple types of fillers available, each with their own unique properties
  • While scars can’t be completely eliminated, fillers can reduce their size and depth 

Dermal fillers, also known as soft tissue fillers, are gel-like biocompatible substances made from natural or synthetic compounds that are injected beneath the skin to manage age-related skin laxity and volume loss. Fillers for acne scars work by filling in and lifting depressed areas, replacing lost volume and smoothening skin irregularities. 

Fillers can be used alone or in conjunction with other treatment modalities. To determine the best treatment for you, your dermatologist will consider the nature, extent and severity of your scars, your expectations, as well as your skin type. 

Understanding How Acne Scars Form

Scarring is, unfortunately, a common outcome of acne. Acne scars occur as a result of the body’s inflammatory response against acne-causing bacteria. They also occur when acne lesions are picked at or squeezed.

While shallow lesions such as papules and pustules may heal completely without scars forming, lesions that penetrate deeply cause greater damage to the skin and tissue. 

If left unchecked, the inflammatory response can damage dermal fat, collagen and elastin, all of which gives skin volume and structure. 

During the healing process the skin produces new collagen that is necessary to repair this tissue damage. Whether or not you develop acne scars will be determined by the type of acne you have, the severity and how it’s treated. 

Deep acne scars vs. raised acne scars

There are two types of acne scars: atrophic scars and hypertrophic scars. 

Atrophic scars appear as shallow or deep indentations and result when the skin is unable to generate enough tissue to fill in scars. 

Atrophic scars are the most common and can be classified into three types: 

  • Ice pick scars are very small V-shaped craters that narrow into a needle-like point deep within the skin
  • Boxcar scars are broad, box-like depressions with sharp, defined edges 
  • Rolling scars appear as large round, depressions with sloping edges that cause a wavy appearance

Hypertrophic scars are thick and raised, and either red or pink in color. These develop as a result of too much collagen being produced. These scars are more common among dark-skinned people due to their darker pigmentation having an effect on the healing process.  

Can Acne Scars Be Treated With Dermal Fillers? 

As fillers are meant to fill depressed areas, they are not effective against raised scars.

While dermal fillers cannot completely eliminate scars, they are proven to be effective to significantly improve the appearance of rolling scars and moderate boxcar scars. They can raise the depressed areas by restoring volume loss for a smoother appearance. 

Dermal fillers are not an appropriate treatment for ice pick scars as these scars are too severe for dermal fillers to be effective.  

Fillers can be used alone, but are usually combined with other therapies as this is more efficacious.

Results are immediate for most fillers, and can last from 3 months to 5 years depending on the type of filler. However, multiple sessions are usually required to achieve optimal results, especially for severe acne scars. Up to 4 sessions are typical for moderate scars; 7 sessions for severe.

How do they work?

Fillers can be injected directly into individual depressed acne scars to reduce their depth and lift them up to the level of the surrounding skin. For deeper scars, they can enhance the results of other techniques, such as subcision.

Fillers immediately restore volume in depressed areas. Most have biostimulatory properties, which means they boost collagen production. Collagen production begins gradually, about 3 weeks after the injection and over time serves to improve skin structure and texture. 

Efficacy vs. other treatments

Efficacy depends on the severity of the scars as well as individual response. Surgical procedures, subcision and microneedling are also effective options as are laser treatments. In a study that reviewed various scar treatments over a 10-year period, researchers found fillers achieved better results compared to microneedling and chemical peels. 

Before and Afters

Best Fillers for Treating Acne Scars

While there are many types and brands of dermal fillers being used to treat acne scars, it is important to know that only one brand is FDA-approved for the treatment of moderate-to-severe acne scars. 

The most common types of dermal fillers are hyaluronic acid fillers (HA), polymethylmethacrylate (PMMA), calcium hydroxylapatite (CaHA) and  poly-L-lactic acid (PLA).

There is no general consensus on what the best filler is; the treatment you will receive will depend on the preference of your provider.   

Bellafill

Bellafill is the only FDA-approved dermal filler for acne scars and is a solution that lasts up to 5 years. 

Bellafill contains bovine collagen and PMMA microspheres. Bovine collagen immediately restores volume loss, while PMMA microspheres provide ongoing structural support beginning in the third week.

Shown to be effective and long-lasting in treating moderate-to-severe atrophic scarring, Bellafill has also been shown to improve widespread scarring in all skin types.

Off-label fillers

Off-label means using a product, treatment or medication for other than for its approved and intended purpose. Among the off-label fillers used for acne scars are:

Juvederm (Juvederm Voluma, Juvederm Ultra Plus) & Restylane (Restylane L, Restylane Lyft, Restylane Silk)

Type & longevityBenefits
  • Temporary; biodegradable; lasts 3-12 months
  • Available in different levels of viscosity and textures for different purposes
  • Can be used to improve large areas of deep scarring or shallow, discreet scars
  • Fully reversible with  hyaluronidase enzyme

Radiesse

Type & longevityBenefits

  • Semi-permanent; biodegradable; lasts up to 2 years
  • Promotes collagen production
  • Provides structural framework for new collagen to build on

Sculptra

Type & longevityBenefits

  • Semi-permanent; biodegradable; lasts up to 2 years

  • Best suited for widespread area
  • Reinforces skin structure
  • Promotes collagen production
  • Improvements in volume are gradual but more durable than other fillers
  • Significantly reduces appearance of atrophic acne scars
  • Fully reversible with hyaluronidase enzyme

What to Expect From the Procedure

Initial consultation

During the initial consultation, your dermatologist will thoroughly evaluate your acne scars and discuss treatment options, the benefits and risks of dermal fillers, and review your medical history.

They may also require a skin test if you choose Bellafill, to ensure you’re not allergic to the bovine collagen. 

This treatment is not appropriate for those with an active infection or skin inflammation. If you are taking immunosuppressive therapy or have conditions that affect wound healing, it is not advised to undergo this procedure. 

Preparing for the procedure 

Dermal filler injections require some preparation. Your dermatologist may instruct you to:

  • Stop all non prescribed blood thinning supplements and medications 1 week prior to the procedure
  • Avoid tretinoin-based skin products 48 hours prior to the procedure
  • Limit sun exposure and use sunscreen with a minimum SPF 30

What happens during the dermal filler procedure

Injectable fillers for acne scars are performed as a simple outpatient procedure in your dermatologist’s office. The entire procedure lasts between 30–60 minutes.

Your dermatologist will begin the procedure by disinfecting the treatment site. They will then apply a topical or local anesthetic to minimize pain and discomfort; some filler brands already contain lidocaine. 

The dermal filler will be injected. Depending on the extent of your scarring, you may need multiple syringes in one session. Tenderness and redness is common immediately afterwards. 

A posttreatment follow-up is usually scheduled 2–4 weeks after the first session. When you return for your follow-up, it will be determined whether or not you will need a second treatment. 

Aftercare

In general, you can resume normal daily activities 4 hours after the procedure, but it is recommended to avoid strenuous physical activity for the next 24 hours. To control post-procedure swelling and pain, you can apply a cold compress or take Tylenol. 

You should keep the treated area clean and avoid massaging your face or sleeping face down. Call your dermatologist immediately if you experience any issues with your vision or worsening pain and bruising within the following 24–48 hours. 

Risks and Complications

Most side effects such as pain, redness, swelling, itching and bruising are mild, and usually clear within 7–14 days. Rare, more severe complications may occur, but can be minimized with proper technique and pretreatment evaluation. These include:

  • Vascular damage: The filler may be accidentally injected into a blood vessel. This can block blood flow and cause permanent skin damage or blindness if not treated promptly 
  • Inflammatory reactions: Hard lumps or granulomas may form on the treatment site if the body mounts an inflammatory response against the filler 
  • Filler displacement: Fillers may migrate and form hard lumps under the skin 
  • Inappropriate filler placement: The filler may be injected too close to the surface, causing a bluish discoloration

Cost of Fillers for Acne Scars

Most fillers are sold per syringe, which usually contains 1 ml or 1.5 ml of filler – with the exception of Sculptra, which is sold per vial. 

  • Sculptra: $700–$1,000 per vial (5 ml)
  • Juvederm: $500–$750 per syringe
  • Restylane: $600–$800 per syringe
  • Radiesse: $600–$800 per syringe
  • Bellafill: $1,000–$1,500 per syringe

For moderate-to-severe scarring, anywhere from 0.5–4 mL of filler may be used per session. If you opt for Juvederm or Restylane, it would take more as the consistency is thinner than fillers such as Sculptra or Radiesse. 

The cost of dermal fillers also varies by geographic location and depends on the fees of your chosen provider. You will also have to factor in the frequency of touch-ups as you will likely need additional treatments to maintain results. 

Takeaway 

While dermal fillers can’t completely eliminate acne scars, they can greatly diminish their appearance by lifting scars, replacing lost volume and regenerating collagen. For the most part, improvements to volume and skin texture are immediate, but if your scarring is severe, it could take multiple treatments to see significant improvement. 

Dermal fillers typically work best for moderate-to-severe rolling and boxcar scars, as well as for widespread areas of deep acne. Fillers can also be an effective addition to other treatments such as incision and microneedling.

Like all medical procedures, dermal filler injections are associated with side effects. Most are mild and temporary, however, in rare instances, severe complications can occur. Dermal fillers are not indicated for those who have medical conditions or are taking medications that put them at risk for bruising, bleeding, infections and delayed wound healing.

Sources

  • Fabbrocini G, Annunziata MC, D’Arco V, et al. Acne scars: pathogenesis, classification and treatment. Dermatol Res Pract. 2010;2010:893080. doi:10.1155/2010/893080
  • Harinatha, Sreekar & Raghunath, Nithya & Reddy, Ravi & Hebbar, Ashwin & Harinatha, Sreeharsha. (2014). Keloid and hypertrophic scar distribution according to fitzpatrick skin phototypes in indian population- an hospital based study. Revista Brasileira de Cirurgia Plástica (RBCP) – Brazilian Journal of Plastic Sugery. 29. doi:10.5935/2177-1235.2014RBCP0057
  • Abdel Hay R, Shalaby K, Zaher H, et al. Interventions for acne scars. Cochrane Database Syst Rev. 2016;4(4):CD011946. Published 2016 Apr 3. doi:10.1002/14651858.CD011946.pub2
  • O’Daniel TG. Multimodal management of atrophic acne scarring in the aging face. Aesthetic Plast Surg. 2011;35(6):1143-1150. doi:10.1007/s00266-011-9715-y
  • Hession MT, Graber EM. Atrophic acne scarring: a review of treatment options. J Clin Aesthet Dermatol. 2015;8(1):50-58. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4295858/
  • Wollina U, Goldman A. Fillers for the improvement in acne scars. Clin Cosmet Investig Dermatol. 2015;8:493-499. Published 2015 Sep 29. doi:10.2147/CCID.S86478
  • Kravvas G, Al-Niaimi F. A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques. Scars Burn Heal. 2017 Mar 30;3:2059513117695312. doi:10.1177/2059513117695312
  • Joseph JH, Eaton LL, Cohen SR. Current Concepts in the Use of Bellafill. Plast Reconstr Surg. 2015 Nov;136(5 Suppl):171S-179S. doi:10.1097/PRS.0000000000001839
  • Karnik J, Baumann L, Bruce S, Callender V, Cohen S, Grimes P, Joseph J, Shamban A, Spencer J, Tedaldi R, Werschler WP, Smith SR. A double-blind, randomized, multicenter, controlled trial of suspended polymethylmethacrylate microspheres for the correction of atrophic facial acne scars. J Am Acad Dermatol. 2014 Jul;71(1):77-83. doi:10.1016/j.jaad.2014.02.034
  • Joseph JH, Shamban A, Eaton L, Lehman A, Cohen S, Spencer J, Bruce S, Grimes P, Tedaldi R, Callender V, Werschler P. Polymethylmethacrylate Collagen Gel-Injectable Dermal Filler for Full Face Atrophic Acne Scar Correction. Dermatol Surg. 2019 Dec;45(12):1558-1566. doi:10.1097/DSS.0000000000001863
  • Halachmi S, Ben Amitai D, Lapidoth M. Treatment of acne scars with hyaluronic acid: an improved approach. J Drugs Dermatol. 2013 Jul 1;12(7):e121-3. https://pubmed.ncbi.nlm.nih.gov/23884503/
  • Goldberg DJ, Amin S, Hussain M. Acne scar correction using calcium hydroxylapatite in a carrier-based gel. J Cosmet Laser Ther. 2006 Sep;8(3):134-6. doi:10.1080/14764170600891632
  • Sadove R. Injectable poly-L: -lactic acid: a novel sculpting agent for the treatment of dermal fat atrophy after severe acne. Aesthetic Plast Surg. 2009;33(1):113-116. doi:10.1007/s00266-008-9242-7
  • Alam M, Kakar R, Dover JS, Harikumar V, Kang BY, Wan HT, Poon E, Jones DH. Rates of Vascular Occlusion Associated With Using Needles vs Cannulas for Filler Injection. JAMA Dermatol. 2021 Feb 1;157(2):174-180. doi:10.1001/jamadermatol.2020.5102
  • Miles H Graivier, MD, Lawrence M Bass, MD, Z Paul Lorenc, MD, FACS, Rebecca Fitzgerald, MD, David J Goldberg, MD, Gottfried Lemperle, MD, Differentiating Nonpermanent Injectable Fillers: Prevention and Treatment of Filler Complications, Aesthetic Surgery Journal, Volume 38, Issue suppl_1, May 2018, Pages S29–S40, https://doi.org/10.1093/asj/sjy032

» Show all

Latest Articles