Acne Treatments

Best Acne Treatment Options in NYC: Lasers, Extractions, Skincare and More

Acne Treatment

Acne Treatments Best Advanced Care and Solutions by Dr. John Kang MD

Did you know that human skin consists of three layers: the epidermis, the dermis, and the subcutis. Did you also know that the epidermis, which is the upper level of skin, are constantly replacing themselves every 27 to 28 days. This shedding process as the most superficial cells are replaced by new ones is called exfoliation. Normally the most superficial dead cell collect in the skin pores, then slowly rise to the surface of the opening and eventually shed away from the skin. Sebaceous glands attached to the pores produce natural body oil called sebum which help to prevent skin cells from drying out. The renewal process of the epidermis along with the protective mechanism of sebum oil can sometimes breakdown and create acne from three root causes:

1. Sebaceous glands become hyperactive causing excess sebum oil build up
2. Which in turn can cause the shedding dead cells to clump together and plug up the pores
3. Bacteria in and around the blocked pores called Propionibacterium acnes can enter and infect the clogged pores by multiplying rapidly, eventually leading to pimples and pustules associated with acne breakouts.

In many instances, acne break outs will result in certain degree of discomfort and pustule formation. This causes many to attempt to squeeze the content, which can in turn create further injury to the skin. Ultimately, there is a greater degree of blemish to deal with, often for weeks to months after the acute inflammation has subsided.

There are two categories of acne treatment that Dr. Kang provides.

I. First category is treating patients experiencing active acne breakouts.
II. Second category is treating patients with less acne breakouts but suffering from persistent discoloration and acne scars.

I. Treating patients with ‘active acne breakouts‘:

The cause of active acne breakouts is always multifactorial including

– genetical predisposition,
– hormonal, and
– environmental.

We usually recommend that patients initially undergo a comprehensive diagnostic work up with their dermatologist and treatment as necessary using the various topical and oral medications available.

However for patients:

– continuing to suffer active breakouts despite topical and oral medications,
– for those who no longer wish to be on a cookie-cutter regimen creating excessive drying of skin from topical solutions and side-effects associated with long-term oral antibiotics,
– for those suffering from life-long acne breakouts or adult-onset acne breakouts,

we provide a comprehensive regimen of skin care treatments that attempt to treat the active acne breakouts from all ‘three root cause’ perspectives using a combination of

1. medical grade facial treatments and
2. various combination of lasers.

Medical facial treatment includes:

1. deep pore cleansing using either Microdermabrasion or HydraFacial followed by
2. gentle extraction and face calming treatments, and
3. finishing up with Blu light photodynamic therapy which reduces the bacterial load causing the acne breakout.

Patients are usually placed on an intense regimen every two weeks for the first five sessions and monthly thereafter for another five sessions. Thereafter, Dr. Kang and staff will re-evaluate and recommend best interval options to keep your skin healthy and looking its best.

For the past 20 years Dr. Kang has been providing this comprehensive medical grade facial treatment consisting of:

1: gentle exfoliation of the outer-most dead layer of the skin called the stratum corneum using Hydrofacial or Microdermabrasion followed by
2. unclogging of the blocked pores, and finishing up with
3. use of the blue light therapy to reduce the bacterial load.

This comprehensive facial treatment have proven to be extremely effective; and, in many instances, the only treatment modality needed for many of our patients who are acne prone. The truth is, even if you are not acne prone, periodic medical grade facial treatment is probably the best way to keep your skin optimally healthy and looking its best.

At the end of 5 intense facial treatments, patients are re-evaluated and given the option of adding laser therapy to their regimen.

Acne laser treatments work by targeting the two remaining root causes of acne which are the
1. overproduction of oil and
2. bacteria in your skin.

While skin calming component of the facial treatment help with overproduction of oil and blue light therapy with controlling the bacterial load, laser therapy treats these two root causes at a whole new level of efficacy.

In our practice for the past 15 years, we have been using Sciton 1319 laser to
1. effectively shrink down the sebaceous glands and at the same time
2. kill the common bacteria which cause the acne breakouts.

In addition the Sciton 1319 has proven to be one of the golden standard of laser treatments for stimulating new collagen to minimize acne scarring as well as to improve old acne scars.

In addition, at the same setting, we use Sciton BBL with 590 filter to provide “acne photo facial” to hasten the clearing of uneven tone and blemishes associated with acne as well as tone down persistent post inflammatory pigmentation issues seen in acne patients with darker complexion.

Dr. Kang usually recommends 4 sessions every 3 to 4 weeks to see the optimal benefit. The range of power settings are always individualized by Dr. Kang to minimize the down time as the last thing that acne prone patient want is more red and blotchiness from laser therapy, even if they are transient at best. The best part is that the Sciton 1319/BBL therapy can be safely used in patients from the light to darker skin color, all year long.

Hollywood peel

As an alternative regimen, we also offer patented Lutronic Spectra Peel (better known as the Hollywood peel) using dual pulse mode technology.
1. Carbon lotion is applied onto the skin and allowed to seep deep into the pores.
2. The laser is applied in Spectra Mode to gently heat the carbon lotion.
3. The laser is then applied in Q switch mode to effectively vaporize the dried carbon lotion deep in the pores.

This patented dual pulse Spectra Peel will:
1. reduce the sebum production,
2. exfoliate the stratum corneum,
3. improve the blemishes, and
4.stimulate collagen regeneration.

By the end of four to five laser sessions, many patients see reduction in active acne and improved acne scars. The added benefit is that as the skin tone softens and skin texture improves, many patients will also note reduction in pore size and improvement of fine lines and wrinkles, ultimately resulting in a clearer, younger looking skin.

Conversely, for many patients who embark on 4 to 5 sessions of Hollywood Spectra Peel for fine lines and a greater glow to their skin, they note less “nuisance” acne breakouts often triggered by stress and hormonal surges. Lutronic Spectra Hollywood Peel can also be safely used in patients from the light to darker skin color, all year long.


II. The second category is treating patient ‘suffering from acne scars and discoloration‘:

For many patients, acne presenting as whiteheads, blackheads, or superficial pustules will not result in any significant residual scars. But for many patients experiencing the deeper nodules, papules, and cystic type of acne lesions, a greater chance exist for permanent acne scar formation during the repair process once the acute inflammation have resolved.
The scars will result in textural changes in forms of either “indented” areas (atrophic scars from not enough collagen formation) which is more commonly seen than “raised” areas (hypertrophic scar or keloid due to excess collagen formation). Atrophic scars usually have the appearance of rolling, boxcar, or ice-pick textural changes.

Rolling acne scars tend to be shallower with softer and smoother shoulders like a saucer shape, and respond better to laser therapy then other types of atrophic acne scars.

Fraxel Re:store 1550

For Acne Scars

For acne scars, Fraxel Re:store 1550 laser technology has proven to be one of the golden standard of treatment available, and Dr. Kang has been treating his patients suffering from acne scars with great success using the Fraxel technology for nearly the past 15 years.

Fraxel is the first laser to introduce the revolutionary “non-ablative fractional resurfacing” technology. In a nutshell it offers, through a series of 3 to 4 sessions results similar to the more traditional single session “ablative” resurfacing laser. However, without the associated side-effects of intense and prolonged downtime and the greater chance of post inflammatory hyper-pigmentation associated with ablative laser therapy.

Fraxel technology works by delivering an array of high precision micro-beams to create deep, narrow column of injury in epidermis and dermis, which are known as micro thermal zones (MTZs). The MTZ then triggers a restorative healing response that stimulates new collagen and elastin production over the previous acne scars, all the while allowing for rapid healing of the injury by preserving the healthy skin in between the MTZ columns of laser spots.


Another excellent laser to help with the acne scar is the Cynosure Affirm which also utilizes the “non-ablative fractional resurfacing” technology.

Unique to Affirm is Cynosure’s patented “Multiplex” technology which has been so successfully applied in their ‘Smart-Lipo Triplix laser platform’. The “Multiplex” technology basically delivers two different laser wavelength 1320 and 1440 simultaneously in one pulse. 1440 emits energy to the upper layer of the skin where typical sun damage change occurs while 1320 emits energy to the deeper layer to promote production of new collagen and elastin, making it one of our favorite choice of laser to treat acne scars, stretch marks, and wrinkles.

Because Affirm Multiplex can deliver 1000 pinpoint laser energy in a 10mm spot using optical lens that allows less energy to be applied without compromising the effectiveness, the treatment session is quicker with less discomfort compared to other comparable laser systems.

For both Fraxel and Affirm, optimal benefit is seen usually after 3 to 4 sessions. Unlike certain laser toning techniques where the laser energy is purposely kept low to minimize hyper-pigmentary issues, to treat acne scars and deep wrinkles effectively, energy is progressively elevated with each session.

A sound clinical judgement must be applied and individualized for the patient when dialing up the energy while combining an effective protocol to minimize post laser discomfort and side-effects.

This individualized program is the key to a successful laser treatment for acne scars. For most patients using this program, side effects are minimal and include mild pain, redness, and swelling, which can last a few hours to rarely a few days. For patients with medium to darker skin color, a possibility of transient post inflammatory hyper-pigmentation exists.  So, at the time of consultation, Dr. Kang will carefully evaluate your acne scars and place you on the optimal regimen to achieve the best result while minimizing down-time and any chance of side-effects.

The Picosecond Lasers

the latest and newest generation laser system

The Picosecond Lasers are the latest and newest generation laser system which deliver ultrashort laser pulses in the picosecond range or within a trillionth of a second. The laser is 100x faster than most other lasers and capable of delivering quick results with fewer treatments.

Originally intended to be the best laser technology for tattoos and all types of pigmentary issues, the companies working with Pico technology have developed a system to concentrate laser light even further.

In the case of Cynosure Picosure laser (first company to develop the Pico technology), it is the only picosecond laser to harness 755nm in their proprietary “Diffractive Lens Arrray (DLA) or focus Lens Array (FLA)” system to produce concentrated micro photo-mechanical cavities under the skin coined LIOB (laser induced optical breakdowns). It is the LIOB which allows acne scars to heal by forming new collagen and elastin. It has proven to be so effective that it has received FDA approval for treating acne scars and wrinkles since 2014.

What makes this system so unique is that due to its rapid delivery of laser light, the energy imparted onto the skin is is more “mechanical ” rather than the traditional “thermal” energy.

The implication is that similar type of collagen stimulation and repair of acne scars can be achieved compared to other golden standard laser such as Fraxel systems, however now with even less down time in terms of prolonged redness and hyper-pigmentary issues.

Picosecond Lasers as result has become the most sought after laser for medium to darker colored patients looking to improve combination of acne scars and pigmentary issues, often seen in patients of Asian descent.


For patients also suffering from combination of pigmentary as well as red spots, usually from combination of past acne scars, sun exposure, and aging, both Fraxel and Affirm can help improve with the discoloration. However to further address these spots, we offer Photo-Facial Therapy using either Sciton BBL or Cynosure ICON MaxG. For deeper pigment issues, we can also spot treat with our Lutronic Spectra Q switched 532/1064, which is so effective that it has even received a FDA label for Malasma treatment. Of course Cynosure Picosure using 755 FLA system is another great option for pigmentary issues. For acne scar patients with more vascular undertone due to broken vessels, dermal thinning, ruddy complexion associated with Rosacea, or simply sensitive acne prone skin which easily reddens, we offer both Cynosure ICOn MaxG and Gemini 532 for vessel toning.

Finally, as we all age, for some of us who have previously suffered the ravages of acne scarring, the natural loss of collagen and fat volume in our face can worsen the appearance of acne scars. For many of these patients, a little lifting effect from Thermage, Ulthera or thread-lifting or volume restoration to more youthful face using fillers or fat transfer, often combined with micro-needling with Platelet Rich Plasma therapy can do wonders to improve not only the aging appearance but the acne scars.

In closing, acne breakouts can be a mere fleeting experience for many patients. However for others, it can be a near life-long journey of acne breakouts with all the frustration and embarrassment it brings which can really create a havoc in your psyche. To make matters worse, each blemish can lead to an indelible mark in the ways of a permanent acne scar.

From this reading, we hope that you understand:

1. why you have acne breakout
2. The three root causes of acne breakouts
3. Various proven treatment protocols to reduce the acne break outs as well reduce the appearance of acne scars and associated discoloration.

 

When you come in for consultation, Dr. Kang and his support team will carefully evaluate your acne related conditions and recommend the best treatment plan individualized to your needs based on all the factors discussed above.