WHAT IS Acne Scarring?
Scarring from acne can be a very frustrating and persistent cosmetic flaw. Acne is the most common dermatologic complication in the United States, and a large majority of those with acne will develop some scarring. Genetics, the severity of acne, and delayed treatment are the main factors that influence scar formation. As we age, these acne scars can become more visible. Early acne treatment can help to prevent permanent scarring and hyperpigmentation.
Acne scarring can negatively affect one’s social and economic opportunities and be detrimental to one’s self-esteem. While prevention is the best avenue for dealing with acne scarring, there are numerous treatment options once scarring has formed. However, there is no single and simple cure. Acne scars are best treated with combination therapy including lasers, light energy, fillers, and resurfacing. Lasers smooth out the scars while fillers fill the scars. Other therapies can address the discoloration from acne scars.
What Are the Types of Acne Scars?
- Rolling scars are depressed scars with sloped edges that merge with normal-appearing skin. They can be circular or linear. They can contain bands of scar tissue underneath that tethers the skin down. They are the most common type of acne scarring.
- Icepick scars are sharp, pointy scars that deeply penetrate the skin. They are more commonly seen on the cheeks. Treatment includes punch excision that removes the scar. This is a minor surgical procedure. The wound is sutured closed. There will be a tiny scar that can fade on its own. The procedure can be followed by a chemical peel or laser resurfacing for improved results when needed or desired.
- Boxcar scars are wide, shallow depressions with sharply defined edges that look like cutouts. Shallow boxcar scars can often be addressed with resurfacing, whereas deeper boxcar scars are treated with more aggressive measures.
- Hypertrophic scars are raised and firm and remain within the borders of the original acne. They are most effectively treated with injections, scar surgery, laser surgery, and cryosurgery.
Treatment options depend upon the type of scar. Options include energy-based treatments like lasers, fractional radiofrequency (RF), and intense pulsed light (IPL). Nonenergy-based treatments include surgery, dermabrasion, microdermabrasion, micro-needling, dermal fillers, and chemical peels. The choice of treatment or combinations will also depend upon the risk for post-inflammatory hyperpigmentation.
- Acne scar surgery involves a minor procedure to make the scar less noticeable by lifting the scar or breaking up the scar tissue. Subcision is the procedure where the scar tissue is broken up to induce new collagen formation to fill the depressed scars. It may be combined with laser treatments for improved results. This approach is best for a few depressed or raised scars. When used for raised scars, the surgery is often followed by injections of corticosteroids.
- Skin resurfacing with lasers, chemical peels, dermabrasion, and microdermabrasion is best for patients with widespread shallow depressed scars and raised scars. Resurfacing will make these scars less apparent.
- Laser skin resurfacing uses fractional pulses of laser light to break down the scar tissue and generate healthy new skin to improve the scar’s tone and texture. It works on all types of scars, raised, depressed, and pinpoint scars. Typically, a series of treatments are recommended depending on the degree of correction needed.
- Fractional radiofrequency microneedling has been shown to be clinically effective in improving acne scars and inducing collagen formation and tissue remodeling with minimal downtime.
- Intense pulsed light (IPL) is a treatment using short bursts of intense light to improve the appearance of hypertrophic scars reducing the height, redness, and hardness of the acne scars.
- Skin fillers can be injected into depressed scars using a collagen-stimulating hyaluronic acid filler, or your own fat. Some fillers are permanent, and some are only temporary.
- Radiofrequency skin tightening heats the skin to stimulate new collagen formation to remodel scars making depressed scars less obvious. It is best for mild to moderate scarring.
- Microneedling causes the skin to produce collagen to fill in depressed scars. Microneedling has a lower risk of post-inflammatory hyperpigmentation.
- Retinoid creams (Vitamin A analogs) can stimulate collagen formation and improve the appearance of acne scars.
- Chemical peels remove the damaged outer skin layers leading to improvement in the appearance of acne scars. Multiple types of chemical peels, ranging from mild to strong formula strengths. The choice of chemical peels is determined by each patient’s goals and needs.
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