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Acne Scars – Treatment Options

Once the acne is gone or under control the next skin problem on your skin woe’s radar may be scarring. The acne is long gone; but you’re left with an unsightly permanent reminder of your battle with acne in the form of scarring. Fortunately it may be easier to rid yourself of the acne scarring then it was to get rid of the acne condition that led to it.

Medical and technological advances in acne scar treatment have made it possible to minimize and in some cases completely erase acne scarring. Long gone are the days of the cringe inducing Dermabrasion procedure that planed and blasted off the skin’s surface leaving behind a weepy, oozy raw complexion. Today’s acne scarring treatments range from: At-home skincare to lunch-time Micro-Dermabrasion sessions to deep chemical peels to lasers to fillers and minor scar revision surgery. There’s certainly a treatment available to address the many levels and complexities of acne scarring.

Which Type of Acne Scarring Do You Have?

To understand which treatment or combination of treatments is best suited for your level of acne scarring entails a bit of knowledge about the type of scarring present on your skin.

One quick note here before we delve further into acne scar treatments. If you have flat, red or reddish spots or discoloration (dark spots) left at the site of a resolved acne lesion – that is not a scar. Many people think the left over spots are skin scarring, they are Post-Inflammatory pigmentation which should resolve/fade over time. They resolve quicker with treatments such as gycolic peels (at home) or professional chemical peels.

There are two categories of acne scarring: scars caused by tissue loss (loss of collagen) and scars caused by too much tissue creation (over-production of collagen). Facial scarring caused by loss of tissue results in scars commonly known as icepick scars, boxcar scars and rolling scars. Those types of scars respond well to treatments such a punch excision, micro-dermabrasion, laser resurfacing, chemical peels and other combination therapies. Keloids are scars caused by the overproduction of collagen which causes the skin to form raised nodules of varying widths and depths. Keloids respond well to treatment with retinoids, steroid creams and injections, and some laser applications. Cutting or otherwise irritating keloid scars may result in further scarring in keloid form.

Use the descriptions below to determine what type of acne scars are present on your skin.

  • Ice Pick Scars -Look like deep pores, have steep sides, jagged edges and give the skin the appearance of having been pierced by an “ice pick”. Ice pick scars can be either shallow or quite deep.
  • Boxcar Scars – Wide oval/ round depressions, may have evolved from an ice pick scar, have steep sides, jagged edges and give skin a “pitted” appearance like orange skin. Severity of boxcar scars range from superficial to deep.
  • Rolling Scars – Wavy scarring instead of deep holes, sloping rounded edges, looks like valleys and hills across the skin. These are typically circular or linear in form and can range from superficial to severe.
  • Combination acne scarring – one or more scar types as listed above.

Best Treatments For Acne Scars Based on Scar Type

Professional Level – Dermatological surgery or cosmetic surgery.

Dermal Fillers– collagen ( bovine, Restylane, Artecoll and others), fat (your own) or hylauronic acid can be injected into the scar to elevate it to the same level as the surrounding non-damaged skin. Fillers are typically temporary solutions with a life span of 3 to 6 months depending on the filler material used. (Typically used on Boxcar scars)

Dermatological Surgery:

  • Scar excision (also known as “punch excision”) where the scar is cut-out and the skin is held together either through sutures or derma glue, in some cases a small skin graft can be used to fill the hole. The hole caused by the scar is replaced with a faint linear scar which can then be treated by chemical peels, micro-dermabrasion or laser resurfacing to minimize its appearance. (Typically used on Ice Pick scars and Boxcar scars.)
  • Scar subscision occurs when the underlying damaged scar tissue is lifted up and away from non-damaged skin. (Typically used on Rolling scars.)
  • Skin grafting is normally used when there is extensive skin damage from acne scarring. The damage typically corrected by skin grafting is known as sinus tracts because the scarring resembles extensive tunnels.

Chemical Peel treatments over time can help lessen the appearance of acne scarring. Works well for fading post inflammatory pigmentation and minor acne scarring – shallow scars. Deeper more potent chemical peels can be used for more severe acne scarring and skin retexturing.

A series of Micro-dermabrasion treatments can improve the look and feel of skin with minor acne scarring-shallow scars. Micro-dermabrasion is also used to help fade linear scars resulting from scar excision and works well to help resolve post-inflammatory pigmentation.

Laser Resurfacing is a popular acne scar treatment, one that has helped push the barbaric skin dermabrasion surgery into the medical health books. Ablative Laser resurfacing removes the damaged and scarred top layer of skin while it tightens the middle layer, giving the skin a smoother appearance. Fractional Laser Resurfacing is a non-ablative technique which means that it doesn’t remove the top layer as do many other laser resurfacing treatments. The Fractional laser concentrates on tightening the middle layer of skin and increasing collagen production so that skin looks smoother.

Fraxel is a relatively new acne scarring and wrinkle “erasing” laser technology that holds a lot of promise. I’ve seen incredible before and after photos of patients with mild to moderate to severe acne scarring and their skin looks markedly improved after Fraxel treatment(s). (Image below, courtesy of Faces Plus via fraxel.com site)

Fraxel Laser Before and After

At-Home Acne Scarring Treatments

Very mild and superficial acne scarring may improve with the use of at home treatments. Glycolic peels, Micro-dermabrasion, Vitamin C, Copper Peptides and prescription retinoids (retin-A) can help exfoliate the skin and promote collagen creation which will give the skin a smoother appearance.

Hope for Acne Scar Treatments

Your dermatologist will be able to tell you which acne scarring treatment or combination of treatments will work best for you. Just know that you don’t have to suffer with the after affects of acne – there are viable treatments out there.

Submitted by Ms. distressedDERMA on Tuesday, 1 April 2008


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3 Responses to “Acne Scars – Treatment Options”

  1. 1

    SCV Mom Says:

    A good friend of mine suffered from adult acne a year or two ago. She has undergone a few of the treatments you mentioned and her skin is amazingly beautiful now. You’d never know she had acne scars. It is really amazing.

  2. 2

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  3. 3

    Raaj Says:

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