Shine MD is a physician led skin care and medical aesthetics clinic based in Vancouver, BC. The Acne Clinic at Shine MD is setting a new standard in our approach to acne and acne scarring. We are committed to providing comprehensive treatment plans to address active acne and acne scarring.
When we consider our approach to acne scarring at Shine, many factors come into play. Response to treatments and results vary from patient to patient. Results are progressive and gradual.
This patient pictured above had a series of five Forever Clear BBL treatments to help reduce acne and redness. Medical management of acne was supervised by Dr. Khurana. After her series of Forever Clear BBL, she was treated with a Shine MD Gold Standard Acne treatment that consists of subcision with platelet rich plasma followed by a Halo laser. Her final photo is a one month follow up post Gold Standard.
What type of scarring is present?
Most patients have a combination of scar types.
Scars that change the texture of the skin are classified as boxcar scars, ice pick scars and atrophic (rolling) scars. All of these types of scarring respond to treatment with the Halo Hybrid Laser. Depending on the type of scars and the severity, multiple treatments are usually required to progressively remodel the skin.
At Shine MD, we have performed many procedures on patients of all skin types, with all degrees of acne scarring. The best results in any one given treatment combination are achieved with the use of the Gold Standard. This treatment series consists of subcision with platelet rich plasma (physician performed) and Halo Hybrid Laser treatment. For severe acne scarring, microneedling can be added to this treatment to further improve your results. TCA CROSS can be added to target icepick or boxcar scars.
Boxcar Scars are best treated with full field ablative treatments such as the Halo Hybrid Laser or the Contour TRL Laser Peel which can be coupled with microneedling. Microneedling alone is also effective for this type of scarring, however, microneedling requires multiple treatments spaced one month apart. Many patients choose to do a Halo laser instead as the Halo Hybrid laser improves both texture and pigmentation and advances improvements in scarring more quickly than microneedling. For patients who seek a gradual and progressive improvement, minimal downtime, less pain and lower cost per treatment, microneedling remains the ideal option.
Ice Pick Scars can be improved with resurfacing lasers. The most definitive approach to improving these deep columnar scars is to perform a minor surgical procedure called punch grafting. A circular incision is made around the ice pick scar and a stitch is placed to bring the skin together. The stitch is removed after five days. A small line may develop in the skin as it heals. The resulting line or scar is then improved with resurfacing lasers or microneedling. TCA CROSS technique is also an option with four treatments spaced two weeks apart or in conjunction with a laser treatment.
Atrophic Scars are wavy depressions in the skin. These are most often caused by cystic or nodular acne. Research and clinical observations show that these are improved significantly with a series of subcision and PRP. When followed by laser treatment such as the Halo and Microneedling the results are significantly improved. As the atrophic scars have decreased volume beneath them, they are then treated with a biostimulator called Sculptra. A series of three treatments, one month apart are performed. Changes are progressive and subtle over six months as your body makes collagen to fill in the wavy depressions in the skin.
Textured scars with pigment can be improved with the use of the Halo laser. Flat pigmented scars can be treated with the Forever Young BBL, or the Moxi Laser and topical skin care.
Post Inflammatory redness is treated with the Broad Band Light Forever Clear or Forever Young Laser. If you have ongoing acne and redness, then the Forever Clear is your best option. Patients who have acne rosacea, flushing or redness will always benefit from the Broad Band Light laser treatments.
Hypertrophic or keloid scars occur from the production of excess scar tissue and are best treated with steroid injections. For these patients, aggressive treatment of acne is recommended to avoid further keloid scarring.
Trifecta Laser with Halo and Profractional for his initial treatment. He had two additional Profractional Lasers,
one Broad Band Light Forever Young to improve redness and a Moxi laser to complete his treatment plan.
The treatments were performed over nine months.
What is the patient’s skin type, skin color and ethnic background?
At Shine MD we take pride in offering an array of treatments that can cover virtually every skin type.
The patient skin type will dictate the best modalities for a patient. For example, a dark skinned patient with boxcar and pigmented scarring will be safest receiving a Halo laser and/or microneedling as these treatments are the least likely to cause hyperpigmentation from the laser energy.
A light skinned patient with boxcar scarring can certainly be treated with the Halo but may also benefit from a customized laser peel to target the problem areas. The risk of hyperpigmentation is lower on lighter skin types.
Patients with skin of color are at risk of developing pigmentation as a result of their acne scarring. In these situations, Halo or Moxi lasers with adjunctive medical grade skin care and pigmentation protocols are an ideal approach.
Lighter skin types and some Asian skin types will have post inflammatory redness.This is approached with the Broad Band Light Laser over a series of treatments.
Acne scarring treated with Microlaser Peel and Three Profractional Lasers over six months.
Mild post inflammatory hyperpigmentation was improved with Triluma and Moxi Laser
What are the patient’s goals?
Patient goals are the driving force for any treatment plan. Some patients are very concerned by certain components of the scarring and less so with others. This is carefully considered in building treatment plans. Reasonable expectations are discussed based on the extent of acne scarring.
Is acne still occuring?
The most ideal acne scar removal treatment plan is performed in the absence of acne. If you still have acne, then acne treatment is encouraged under the care of a physician. This is covered by the Medical Service Plan of British Columbia and is available at Shine MD. It is important to minimize the presence of acne or pimples before you start your intensive acne scar treatment journey.
If you still have acne and want to start acne scar treatments, the physician might recommend a low dose antibiotic that is compatible with laser treatments. Aviclear laser is another option that helps reduce acne and acne breakouts. This can be performed on its own or in combination with acne medication. After your acne scar treatment plan is completed, then you can complete a course of isotretinoin or undergo a series of Aviclear Treatments to permanently reduce your acne.
What is the time frame and budget?
The team at Shine MD is very invested in your process and we will work with your timeframe and budget to get you the best outcomes possible. If you have a special event or life milestone that is coming up we can help you with your treatment plan in a way that feels accommodating and manageable.
Why are we so committed to acne?
My commitment to acne and acne scarring grew from my experience with acne scarring and having skin of color.
I developed severe scarring acne when I was 31 years old, during my residency. I completed a course of isotretinoin over 8 months. I delayed starting a family so I could treat my acne.
Throughout my thirties, although my acne had improved after Accutane, it continued in a mild form. Each lesion left a new scar of texture and pigment. Finally at 42, I decided to try to improve my skin.
After consulting with care providers, I was surprised and disappointed that I could not find a place where the team was taking ownership of my skin journey. I was worried that laser treatments would cause more pigmentation. I could not find clarity on which treatment would improve my skin with the highest safety and lowest side effect profile. I could not find a clinic or physician that felt entirely confident treating my South Asian skin.
This journey motivated and inspired me to create this safe space for acne treatments and acne scarring treatments, recognizing that medical management of acne is an essential component to building treatment plans for patients. Having skin of color, I became committed to developing protocols and understanding how to maximize and combine different treatments to better serve our patients.
In two years, Shine MD has become a destination for patients with acne, acne scarring and skin of color. We look forward to supporting you on your skin care journey.
My Halo Laser Photos
These baseline photos were taken in November 2019. The healing series is taken following my Halo treatment in January 2020. As you can see, the collage highlights my five day journey post Halo treatment. This single treatment transformed my life and my confidence. I could not have imagined that there was a technology that could improve pigment and texture and be safe for my skin type, with no collateral damage.
My first Halo treatment helped me choose the amazing technology that would enable us to change lives when it comes to facial rejuvenation and acne scarring. The Halo laser is an award winning technology that is unsurpassed in its effectiveness, versatility and safety profile across different skin types.
Check out this patient’s Halo treatment journey.
The Gold Standard
We have been refining our approach to acne scarring in our ongoing mission to bring you the best, most diverse and comprehensive options for acne scarring.
Dr. Khurana has completed additional training in utilizing various lasers and resurfacing techniques to optimize patient outcomes. Based on our experience we have developed the Shine MD Gold Standard for Acne Scarring. In this treatment sequence, the use of subcision and PRP has become an essential part of scar treatments for moderate to severe acne scarring. Subcision and PRP is followed by a Halo Hybrid Laser, with settings customized to suit your scar type and skin type. If your scarring is severe, stacked treatment with microneedling further boosts collagen production. TCA Cross is performed in conjunction with your Gold Standard to target deeper scars.
Results vary from patient to patient, also highly dependent on the severity of scarring. Many patients will repeat all or portions of the Gold Standard many times based on their budget and tolerance for downtime and treatment goals.
Evidence Based Practice: Platelet Rich Plasma Augments Subcision in Atrophic Acne Scars: A Split Face Comparative Study
Acne scarring treated with a series of three consecutive Gold Standard one month apart: Three Subcision/PRP, 1 Profractional
Laser and Two Halo Laser over the course of 4 months. The patient continues his journey with BBL for redness improvement. He is
completing a series of Sculptra treatments, one month apart to further improve the appearance of atrophic scars.
What else can we do for acne scarring?
At Shine MD, Dr. Khurana incorporates the use of Sculptra and TCA Cross to target different scar types.
The patient pictured above had a series of treatments at Shine MD. As we progress in her treatment plan, she has seen further improvement in the appearance of acne scars after two sessions of Sculptra. Sculptra sessions are offered as a series of three treatments one month apart, with results additive and progressive over time. Sculptra is a polymer that is injected under the skin and into shallow box car scars to help the body produce collagen, thereby filling the scars and smoothing out the skin texture.
Sculptra is a biostimulator that helps improve the appearance of atrophic scars by stimulating your body to make collagen. Three treatments are performed one month apart and the results become visible gradually as your body builds collagen.
TCA CROSS is another in-office procedure that improves the appearance of shallow boxcar scars and icepick scars. Trichloroacetic acid is applied to the scars by a physician. This acid causes inflammation in the skin and new collagen forms in these areas. The TCA can be applied before a laser procedure or as a stand alone treatment. A series of four treatments two weeks apart is recommended as an initial approach.
Evidence Based Practice: An Assessment of the Efficacy and Safety of the CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars.
Evidence Based Practice: Evaluation of CROSS Technique with 100% TCA in the Management of Ice Pick Acne Scars in Darker Skin Types.
Click here to visit our Acne Scar before and after gallery.
For more information about Acne Scarring and Active Acne Treatment options visit our Acne Clinic page.