Sebaceous Gland Ablation – A History

Electrosurgery is a very common procedure in modern Medicine. Electrosurgical devices are routinely used in Operating Theatres around the world to cut, dissect and ablate tissue. In Dermatology and Plastic Surgery, electrosurgery has been a preferred method ( over excision ) for removing benign skin lesions, due to the superior cosmetic results of electrosurgery. Electrosurgery is the most efficient method of removing tissue as it cuts and coagulates ( seals ) the tissue at the same time, minimising bleeding. Electrosurgery has also long been used for removing lesions below the skin’s surface, such as superficial blood vessels. In the mid 1980’s Dr Toshio Kobayashi began researching the use of electrosurgery for the removal of lesions below the skin’s surface in Japan. His initial work concentrated on hair removal, but the advent of laser hair removal shifted his attention to other intradermal ( in the dermal layer of the skin ) lesions. In 1986, he published a paper on Electrosurgery and the treatment of telangectasias ( intradermal blood vessels ). In 1988, he published a paper on Electrosurgery and the treatment of axillary bromhidrosis and hyperhidrosis ( excessive underarm sweating ). In 2007, Dr Kobayashi published a paper on Electrosurgery and sebaceous glands, for the treatment of facial seborrhoea ( excessive oiliness ). Whilst his work went unnoticed by the rest of the medical profession, Dr Kobayashi had begun treating acne patients with electrosurgery to eradicate their acne. Sadly Dr Kobayashi died shortly after he published his 2007 paper and his work could easily have been completely lost. Dr Ahn, his colleague in Korea has continued Dr Kobayashi’s ground breaking work with SGA and has successfully treated over 3,000 acne patients over the past 4 years.

Here is Dr Kobayashi’s 2007 paper ( click on the link to open ):

Selective Electrothermolysis of Sebaceous Glands

Sebaceous Gland Ablation – What to expect during and after a treatment

During treatment, a fine probe is inserted into the acne lesion and once correctly positioned, a short burst of surgical diathermy is delivered. For most people, they feel the heat of the diathermy but it is very localised and very short. We are able to adjust the intensity of the diathermy for each person, so they can tolerate the treatment. Most clients have stated they found the treatment quite tolerable and are happy to return for further treatments. There can be some bleeding from the acne lesions during treatment and sebum is extracted from the gland after it has been diathermied.

After treatment, the skin is “bumpy” at each treatment point and remains bumpy for 7- 10 days after the treatment. There is no pain or discomfort after the treatment and the skin generally looks less inflammed within a few days of an SGA treatment.

All clients at my Clinic are on prescribed home care routines for their skin, and these are continued whilst they have their SGA treatments.

Sebaceous Gland Ablation – Results

Here are some before and after photos from a study by Dr Ahn from Korea, showing his results from three SGA treatments, spaced one month apart. He presented this study at the World Congress of Dermatology last May. I met Dr Ahn at a conference last November and undertook my SGA training in January in Korea. I am looking forward to having my own before and after photos to show you in a few months time. Some of these before and afters demonstrate a very common problem in the aftermath of successful remission in acne, post inflammatory hyperpigmented scarring. This can be corrected with a programme of prescription creams, which I will detail in another post.

 

Sebaceous Gland Ablation – How many treatments are required?

The number of treatments require to completely destroy each acne affected sebaceous gland depends on the size of the gland and each person’s tolerance of the surgical diathermy. Performing the treatment at a higher setting allows for more tissue destruction however, the treatment must be tolerated, and treating on too high a setting will result in the client being reluctant to return for further treatments! Experience has shown that an average of 2 to 3 treatments are required to completely destroy the sebaceous gland. Treating a large cyst may require more treatments than a smaller pimple.

Sebaceous Gland Ablation can also be used to eradicate blackheads and milia. For these, one treatment is often sufficient.

Sebaceous Gland Ablation – How does it work?

Acne is caused by overactive sebaceous glands. We have thousands of sebaceous glands in our skin and even in the most severe acne cases, only a tiny percentage of the sebaceous glands are affected. Sebaceous glands are fairly close to the surface of the skin, so we can reach them with a specially coated fine probe. Once the probe is in place, we destroy the affected sebaceous glands with short bursts of surgical diathermy. We are able to adjust the intensity of the treatment to accommodate each person’s pain threshold. Most clients we have treated have found the treatment quite tolerable.

SGA progressively destroys each overactive sebaceous gland. We know that the overactive sebaceous gland has been destroyed when there is no breakout in that part of the skin. It can take 2-3 treatments on average to destroy each affected sebaceous gland. Larger cysts may take up to 6 treatments to progressively shrink and heal. It is very important not to over treat  as this could result in a scar forming.

One of the common treatments for large acne cysts is an injection of the steroid triamcinolone acetonide. This can be very effective for destroying and shrinking a cyst but it is also very common to over treat with a resulting depressed scar where the cyst was. This happens as it is almost impossible to control the effect of the steroid on the cyst. SGA is a better option for treating cysts as the destruction and shrinkage is progressive, with additional treatments only done if required, if the cyst is still present.

 

 

 

Introducing Sebaceous Gland Ablation

For the past twelve years, I have looked after thousands of patients with acne, from eight year olds to sixty year olds, and the question they all ask me is “ Is it possible I can be permanently breakout free? “

 

Unfortunately, until now, my answer has always been a qualified no. Roaccutane can deliver long remissions from acne for many people but it still has a relatively high relapse rate, particularly in women and, it is a very powerful drug, that affects all the sebaceous glands in the body, not just the ones that are breaking out. It also has many other side effects that make it unsuitable for use in many people with mild to moderate breakout.

 

I am very pleased to announce that from now on, my answer will be, Yes, it is possible to be permanently breakout free.

 

Sebaceous Gland Ablation (SGA) offers acne affected teenagers and adults a non drug, permanent solution for their acne. SGA is used to treat only those sebaceous glands affected by acne. We have thousands of sebaceous glands in our skin ( approximately 1200 per square centimeter of skin to be precise ). Only a very small number of these sebaceous glands are affected by acne and breakout, even in the most severe cases of acne. These “rogue” sebaceous glands are generally enlarged when they are inflamed and can now be treated, so that the sebaceous gland is progressively destroyed. Once the sebaceous gland is “ablated” ( a medical term using to describe tissue destruction through the use of heat ), it can no longer break out.

 

SGA can be performed on any active acne lesion, from a lesion as small as a blackhead to lesions as large as cysts. Only active acne can be treated, as we use the breakout as a guide to finding the affected sebaceous glands. Multiple treatments are generally required to ablate each sebaceous gland ( between two and five treatments ), so depending on the number of acne and breakout affected sebaceous glands you have, it can take many treatments to become permanently breakout free.

I have created this blog specifically to increase awareness of the existence of SGA and to offer my advise on the most effective treatments available for acne and acne scarring. I look forward to answering your questions and comments.