Acne scars are a common and challenging problem to address, requiring a combination of invasive cosmetic treatments and at-home skincare products for optimal results.

1. Causes of Atrophic Scars

Atrophic scars (pitted scars) are depressions in the skin, formed when the body doesn't produce enough collagen during the healing process of a wound.

Atrophic scars are the result of deep inflammation. Some causes of deep inflammation include acne, chickenpox, and accidents. Among these, acne is the leading cause of atrophic scars. The severity and morphology of the scars depend on the degree of inflammation.

2. Classification of Atrophic Scars

Atrophic scars are typically classified into 3 types:

• Ice pick scars: These are the most common type, fairly deep, shaped like a sharp object piercing the skin, narrow with a diameter of < 2mm, and approximately 0.5mm longer. They frequently appear on the cheeks and forehead.
• Boxcar scars: The base of these scars is relatively shallow and flat, with a diameter of about 2-4mm and a depth of about 1.5mm, appearing on the cheeks and temples.
• Rolling scars: Formed by inflammatory acne, where cysts penetrate deep into the dermis, causing extensive destruction and creating fibrous, pulling scar tissue, with deep bases and wide openings (more than 4-5mm), commonly found on both cheeks and the jawline.

Classification of acne scar severity according to the Goodman and Baron scale:

• Macular scars: the mildest degree, flat scars that are not lower than the skin surface. These scars can be erythematous, hyperpigmented, or hypopigmented.
• Mild scars: usually visible from a distance of less than 50cm and can be easily covered with makeup.
• Moderate scars: clearly visible from a distance of 50 cm or more and not easily covered by makeup.
• Severe scars: clearly visible from a distance of 50 cm or more and not easily covered by makeup. When the skin is stretched, the base of the scar will not be flush with the skin surface like moderate scars.

3. Scar Treatment Methods

The general principle of scar treatment methods is to create micro-injuries to activate the healing process and collagen proliferation. This regenerates the scarred skin and replaces it with healthy, fresh new skin. Common scar treatment methods currently include:

3.1. Fractional CO2 Laser

This is the most widely used method in Vietnam. Fractional CO2 Laser uses energy at a wavelength of 10,600 nm to create micro-injuries on the skin, stimulating the formation of new collagen. However, as this is an invasive cosmetic procedure, it can cause undesirable side effects after treatment such as erythema and hyperpigmentation. Therefore, Fractional CO2 Laser should be performed by a skilled doctor and requires a strict post-treatment care regimen.

3.2. Chemical Peel

Chemical peel uses an acidic solution applied to the skin to remove the outermost damaged layer and stimulate the repair process, forming new, healthy skin.
The active ingredients and concentration of the peeling solution are chosen depending on the type and severity of the scar. Common peeling chemicals include: glycolic acid (50-70%), Jessner's solution, and Trichloroacetic Acid (TCA) from 25%.

Another widely used technique for treating ice pick scars is TCA Cross. CROSS stands for chemical reconstruction of skin scars. The TCA Cross method uses a high concentration of TCA (50-100%) applied topically to scars on the skin with wooden applicators. TCA is applied for a few seconds until the scar shows a white frosting. This technique can avoid scarring and reduce the risk of hypopigmentation because it does not damage surrounding skin areas.

3.3. Microneedling

Microneedling uses tiny needles to create controlled injuries on the skin. These injuries stimulate the signaling pathways of the healing process and collagen proliferation, thereby regenerating and filling the scarred skin. This method also carries a risk of side effects similar to fractional CO2 laser, but with a shorter recovery time.

4. Topical Active Ingredients

In-clinic treatments only create micro-injuries that stimulate the skin's healing process. Therefore, at-home post-treatment care steps are crucial. Topical active ingredients play a role in vigorously stimulating collagen production and supporting a smooth healing process.

Some collagen-boosting active ingredients include Retinoids, Vitamin C, EGF (Epidermal Growth Factor), and Copper Peptide GHK-Cu (Copper Tripeptide-1). However, after invasive procedures, the skin is quite damaged and cannot tolerate highly irritating active ingredients like Retinoids or Vitamin C. Therefore, EGF and GHK-Cu are safe and effective choices to boost collagen production and complement invasive procedures.

Moreover, performing cosmetic procedures creates favorable conditions for large active ingredients like GHK-Cu and EGF to easily penetrate the stratum corneum barrier and be absorbed better.

4.1. Copper Tripeptide-1 (GHK-Cu)

GHK-Cu is a complex of Tripeptide-1 (Glycyl, Histidyl, and Lysine) linked to the element Copper. Copper is an essential trace element for life that provides essential fatty acids and vitamins to the skin. Tripeptide-1 (GHK) is part of Type I Collagen and can activate the signaling pathway for collagen synthesis. Supplementing with peptides like GHK "tricks" the skin into thinking that collagen has been broken down and it's time to produce new collagen.

The combination of these two ingredients creates the Copper Tripeptide-1 complex, which helps repair, heal wounds, reduce inflammation, and provides antioxidant benefits. It also stimulates the production of important skin components such as Collagen, Elastin, and Glycosaminoglycans (GAGs), thereby improving elasticity, firmness, and reducing wrinkles/fine lines on the skin.

GHK-Cu provides 3 benefits for skin after acne scar treatment:

- Skin repair and regeneration: GHK-Cu effectively heals wounds by stimulating the synthesis of structural skin components such as collagen, elastin, and glycosaminoglycans (GAGs), and regulating the activity of metalloproteinases (collagen-degrading enzymes) to prevent the accumulation of damaged collagen. GHK-Cu has also been shown to have beneficial effects on fibroblasts - key progenitor cells in the skin regeneration process. Fibroblasts not only synthesize the structural components of the skin matrix but also produce a range of growth factors essential for skin repair.

- Scar tissue remodeling: GHK-Cu has a unique ability to break down damaged or excessively large collagen fibers (like collagen IV) that cause keloids and subsequently stimulate the production of healthy collagen. Therefore, GHK-Cu is commonly used after scar treatment procedures.

* In-vitro studies have shown that GHK-Cu has superior properties to Vitamin C and Retinoids.

- Anti-inflammatory: GHK-Cu inhibits pro-inflammatory cytokines such as TGF-β and TNF-α, thus having strong anti-inflammatory effects. It can be used as a topical agent in the treatment of inflammatory skin conditions as an alternative to corticosteroids. GHK inactivates harmful free radical byproducts from lipid peroxidation, stimulates the body's intrinsic antioxidant system such as superoxide dismutase, and protects cells from ultraviolet (UV) radiation.

Suggested product:

oh!oh! Flawless Abyss Serum - a highly-rated and popular serum for atrophic scars in the Korean market. This specialized product addresses atrophic scars, promoting regeneration and providing essential nutrients for skin nourishment. Notably, it is an indispensable product if you have undergone or are planning aesthetic procedures such as laser, microneedling, or chemical peels.

Key active ingredients for skin recovery and regeneration:

• GHK-Cu 1.2%: repairs damaged cells and stimulates the production of important skin components like collagen, elastin, and glycosaminoglycans, thereby filling scars and improving skin elasticity and firmness.
• EGF 9.9 ppm: stimulates the skin to accelerate cell regeneration and restructure the skin, thus promoting healthy skin.
• Centellosides Centella Asiatica extract (asiaticoside, madecassoside, asiatic & madecassic acid): antioxidant, anti-inflammatory, and stimulates GAGs production.
• Pro Anti-Irritant Complex (Dipotassium glycyrrhizinate, Anthemis Nobilis Flower Extract, Allantoin): anti-inflammatory properties, soothes skin, accelerates recovery of damaged, sensitive skin.
• Fucus Vesiculosus extract: notable for its antioxidant properties, protecting the skin from environmental aggressors and preventing early signs of aging.

> > > Find out more about the product HERE

4.2. EGF (Epidermal Growth Factor)

Human epidermal growth factor (hEGF), a polypeptide hormone (53 amino acids) found in the human body, is secreted by platelets, macrophages, fibroblasts, and bone marrow-derived mesenchymal stem cells. EGF plays a crucial role in stimulating epithelial and fibroblast differentiation, enhancing collagen synthesis, and supporting wound healing.

EGF stimulates cell proliferation, differentiation, and survival primarily through the epidermal growth factor receptor (EGFR). When EGF binds to its receptor, it initiates a cascade of molecular reactions leading to cell division and culminates when the DNA in the nucleus expresses a protein and causes several changes within the cell. This results in the following effects:

- Regulates cell proliferation, function, and differentiation through signal-receptor mechanisms.
- Directly impacts the biosynthesis of collagen, elastin, and extracellular matrix (ECM).
- EGF in the dermis of aging skin can promote fibroblast proliferation and restore fibroblast synthetic capacity.
-> This helps accelerate recovery, increase regeneration speed, slow down the aging process, and inhibit wrinkle formation.

A study conducted on 21 patients showed that EGF provided superior efficacy at three months post-treatment compared to placebo. The wound healing response did not differ between the groups. Surprisingly, the melanin index in the EGF group significantly decreased after three months of treatment, compared to placebo. No cases of EGF causing irritation were reported.

In a study on the topical use of EGF after microneedling for scar treatment, Kalil, Frainer, and colleagues (2015) selected 10 patients aged 20-40, of both sexes, who underwent three treatments with microneedling using 2mm needles, applying a mask containing growth factors (EGF, IGF, TGF-beta3). The results showed an overall improvement in skin texture, especially in patients who used EGF after two microneedling treatments.

Suggested Products

oh!oh! currently offers two products containing the epidermal growth factor EGF at a concentration of 9.9ppm (the highest on the market), combined with other advanced active ingredients to optimize skin benefits:

oh!oh! Oatmere Serum - a stem cell serum for skin regeneration after invasive procedures, with a combination of anti-inflammatory and effective wound-healing ingredients:

- 9.9 ppm EGF (sh-Oligopeptide-1): consisting of 53 amino acids, it stimulates epidermal cell proliferation and promotes increased elastin production, restructuring the skin, thereby accelerating recovery and healing of wounds and scars.
- 4.5% Avena Sativa (Oat) Kernel Extract: soothes, reduces inflammation, and heals skin damage. Oats contain high levels of β-glucan, which retains water in the skin and limits transepidermal water loss (TEWL). The avenanthramide polyphenols in oats have effective antioxidant and anti-inflammatory properties.
- Centellosides Centella Asiatica extract (asiaticoside, madecassoside, asiatic, and madecassic acid): antioxidant and anti-inflammatory in wound healing, stimulates the skin to produce GAGs and Collagen.
- Pro Anti-Irritant Complex (Dipotassium glycyrrhizinate, Anthemis Nobilis Flower Extract, Allantoin): anti-inflammatory properties, soothes skin, increases skin's water retention capacity, accelerates the recovery of damaged, sensitive skin.
- Fucus Vesiculosus Extract (brown algae extract): softens, restores, and hydrates the skin, and prevents signs of premature aging.

> > > Find out more about the product HERE

oh!oh! Flawless Abyss Serum - a highly-rated and popular serum for atrophic scars in the Korean market. This specialized product addresses atrophic scars, promoting regeneration and providing essential nutrients for skin nourishment. Notably, it is an indispensable product if you have undergone or are planning aesthetic procedures such as laser, microneedling, or chemical peels.

Key active ingredients for skin recovery and regeneration:

- 1.2% GHK-Cu: repairs damaged cells and stimulates the production of important skin components like collagen, elastin, and glycosaminoglycans, thereby filling scars and improving skin elasticity and firmness.
- 9.9 ppm EGF: stimulates the skin to accelerate cell regeneration and restructure the skin, thus promoting healthy skin.
- Centellosides Centella Asiatica extract (asiaticoside, madecassoside, asiatic & madecassic acid): antioxidant, anti-inflammatory, and stimulates GAGs production.
- Pro Anti-Irritant Complex (Dipotassium glycyrrhizinate, Anthemis Nobilis Flower Extract, Allantoin): anti-inflammatory properties, soothes skin, accelerates recovery of damaged, sensitive skin.
- Fucus Vesiculosus extract: notable for its antioxidant properties, protecting the skin from environmental aggressors and preventing early signs of aging.
> > > Find out more about the product HERE

3. Suggested Skincare Routine

- Within 48 hours post-treatment: During this period, the skin is severely damaged and needs sufficient moisture for the healing process. The skin should be gently cleansed with physiological saline solution and topical antibiotics should be used as prescribed by the treating physician. Additional moisturizing active ingredients such as hyaluronic acid can be used to provide moisture, helping the wound heal faster.

- In the first week post-procedure: Continue using antibiotics as prescribed by the doctor. Apply products that support collagen production and promote the healing process, such as EGF and Copper Tripeptide-1, 2-3 times/day for faster skin recovery. Limit sun exposure; when outdoors, cover up thoroughly and apply a broad-spectrum sunscreen with SPF 50 or higher. If the skin is still too damaged for sunscreen, oral sun protection supplements can be used in combination with physical sun protection.

Suggested skincare routine:

* MORNING:

- Martiderm Essentials Micellar Cleansing Gel is the ideal formula for your morning cleansing routine, gently removing excess oil and dirt without stripping essential moisture, leaving skin clean, fresh, and free from tightness. Additionally, the product contains edelweiss flower extract to effectively moisturize and protect the epidermal skin layer.
>>> See product details HERE

- oh!oh! EOX Defending Tonique not only helps remove residual impurities after cleansing, but also balances pH, hydrates skin, and prepares it for subsequent skincare steps.
>>> See product details HERE

- oh!oh! Flawless Abyss Serum for pitted scars repairs damaged skin and promotes collagen production to fill in scar tissue.
>>> See product details HERE

- Cellular Corrective Cream is a specialized moisturizer for oily skin that helps control excess oil, soothe red inflamed pimples, strengthen the natural skin barrier, and promote long-term healthy skin.
>>> See product details HERE

- Bella Aurora Dark Spot Sunscreen Protects & Unify SPF50+ provides maximum protection, preventing damage from 5 types of rays: UVA / UVB / HEV / IR / WIFI. Turmeric extract helps optimally protect skin from free radical damage and prevents sun-induced skin aging. The oil-free formula has a super-light liquid texture that quickly absorbs into the skin, leaving an invisible, dry, and smooth finish.
>>>> See product details HERE

* EVENING:

- oh!oh! Xylica Micellar Cleansing Water gently removes makeup and dirt with a formula containing Centella Asiatica extract and AQUAXYL™ complex, perfectly balancing pH and ensuring clean, smooth, and fresh skin without the need for rinsing.
>>> See product details HERE

- Martiderm Essentials Micellar Cleansing Gel is the ideal formula for your morning cleansing routine, gently removing excess oil and dirt without stripping essential moisture, leaving skin clean, fresh, and free from tightness. Additionally, the product contains edelweiss flower extract to effectively moisturize and protect the epidermal skin layer.
>>> See product details HERE

- Similarly, use oh!oh! Flawless Abyss Serum for pitted scars.

- oh!oh! Oatmere Serum, a stem cell and skin regenerating serum, with 4.5% oat extract soothes skin, prevents irritation when using high-concentration treatments (BHA, Retinoid), and contains EGF (9.9ppm) to effectively promote cell proliferation and combat signs of aging.
>>> See product details HERE