Moderate and severe acne can create permanent scars, leaving deep marks long after adolescent skin problems have faded. Acne scar treatments help restore damaged skin to a more even and attractive appearance. Because skin tissue typically has excellent healing properties, it’s never too late to attempt treatment for acne scars.
Types of Acne Scars
The best treatment for acne scars will depend on the size, type, and location of each scar as well as the patient’s skin type. Acne scars raised above the level of the surrounding skin called hypertrophic or keloid scars. These raised blemishes caused by excess collagen growth during the healing process. Scars that leave a depression in the skin called atrophic scars. Atrophy causes collagen loss in the skin during acne inflammation, resulting in loss of tissue volume. Boxcar scars (pockmarks) and ice pick scars that look like small, deep holes punched in the skin are examples of atrophic scars. Tissue may also regrow abnormally, connecting the epidermis too tightly to the deeper dermis. The connective tissue tugging from the underside of the skin can result in rolling scars that appear as ripple marks.
CO2 Fractional Resurfacing Acne Scar Treatments
Fractional skin resurfacing is a popular treatment for the ice pick, boxcar, and rolling acne scars. Fractional resurfacing causes small amounts of damage to the skin. The goal is to stimulate the skin to produce more collagen, helping plump up the scarred area and bring it up to the level of the surrounding skin. Ablative lasers cause larger areas of deep damage and have very complicated recovery and a higher risk of infection while non-ablative or fractional resurfacing destroy tiny columns of tissue in the epidermis while leaving the surrounding skin intact. Non-ablative laser treatment has fewer side effects and a shorter recovery time.
Microdermabrasion works in the same way as laser resurfacing–by stimulating collagen production in the damaged tissue. It is performed using a rotating mechanical device rather than a laser. The whirring burr scrapes away the layers of scar tissue, allowing new skin to grow during the healing process. Microdermabrasion sometimes advertised as a treatment for acne scars. However, this less invasive form of microdermabrasion only exfoliates the very top layer of dead skin with good results but does not repair deep scarring.
Surgical Acne Scar Treatments
There are many forms of surgical treatment for acne scarring. They work by removing scar tissue, stimulating collagen production, releasing abnormal connective tissue, or grafting new tissue in place. Examples include:
. Punch excision (removal of ice pick scars)
. Punch grafting (removal of scar tissue and grafting of donor tissue for ice pick scars)
. Subcutaneous incision (release of connective tissue for rolling scars)
. Punch elevation (removal of connective tissue and lifting of boxcar scars)
All of these treatments are outpatient procedures be performed by a Doctor. With any surgical treatment, a new scar may form as a result of the procedure. However, the scar is usually smaller and less noticeable than the original acne scar. All treatments that cause skin damage (surgery, dermabrasion, and laser treatment) have higher risks of side effects for patients with darker skin.
Dermal Filler Treatments for Acne Scars
Sometimes, it isn’t possible to promote enough collagen production to completely even out boxcar acne scars. Injectable dermal fillers can be used instead of collagen to replace lost tissue volume. Hyaluronic acid fillers such as Juvederm can lift the scarred area for a period of a few months before another injection is required. Calcium hydroxylapatite (Radiesse) may correct an acne scar for a couple of years. Artefill, a more permanent filer, may provide results that last much longer. Typically, treatment with long-lasting fillers carries more risks and is not readily reversible if something goes wrong.
Pharmaceutical Treatments for Acne Scars
Patients with dark skin may experience overgrown scars rather than depressed scars from acne. These hypertrophic scars are often treated using topical steroid creams. Special scar reduction tape that releases steroids into the skin while applying pressure to help flatten the raised tissue may also help reduce the appearance of keloid acne scars. Some patients can benefit from interferon injections that help normalize the skin’s immune response and soften abnormal scar tissue.
What Happens after Acne Scar Treatment?
Many of the acne scar treatments listed above can still leave skin looking irregular. Minimally invasive procedures such as chemical peels may help further improve the appearance of acne scars after the skin has a chance to heal. Lightening creams may also be prescribed to minimize uneven pigmentation. While most patients do not see their acne scars completely disappear with treatment, it is possible to make the scarring much less noticeable.
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