Acne Scars 101

Acne manifests itself in one way or another in almost 80% of people in their teens and twenties. Most people recover on their own, or with the help of dermatologic treatments such as washes, gels, oral or topical antibiotics, or isotretinoin (Accutane). But for some, the face is left with residual scarring.

After a lesion heals, it can leave a temporarily red or hyperpigmented area on the skin. This is a post-inflammatory reaction that can stay for 6-12 months, and is best treated/prevented with sun protection, lightening creams, alpha or beta hydroxy acids, tretinoins (like Retin-A), and avoiding touching the skin and prolonging the healing process. One of the most touted methods, Vitamin E cream, has actually been found to do more harm than good!

If the scarring became permanent, or is extensive, these topical remedies will no longer work. Let’s take a look at the types of scars and their treatments.

Boxcar scars are round or oval and have sharp depressions with a flat base (like a crater).

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Icepick scars are narrower than boxcar scars but can go deeper into the dermis and come to a point.

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Rolling scars change the surface of the skin from smooth to assymetric because fibrous bands are pulling at the skin from underneath in different directions.

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Keloid scars are raised, purple, sometimes times painful scars. They occur most often in African-American skin.

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Treatment

Cosmetic Laser Skin Surgery Center offers every type of acne scar treatment. Briefly, here are the basics:

Dermal Fillers: Using agents like Restylane, Juvederm, Perlane, or Radiesse, we can fill in the depressions caused by acne scars. This works well for icepick and boxcar scars where indentations are deep. It’s important to keep in mind, however, that these changes are temporary.

Punch Excision: This method uses a tool to take a “cookie cut” out of the skin from 1.5-3.5mm. The edges are then sutured together and this newly formed “scar” fades to be less noticeable.

Skin Grafting: Using skin from behind the ear, we can remove the disfigured, poorly organized scar tissue and replace it with healthy skin. Though the color or texture may be slightly different, this can be evened out using laser techniques.

Laser Resurfacing: The most common technique for acne scar removal. We can use the Alexandrite pigment laser for hyperpigmented scars, Pulse-Dye for the red scars, and Fraxel for the skin uneveness, large pores, and scarring. Fraxel re:store accomplishes change over a series of 3-5 sessions using a numbing cream. Fraxel re:pair uses anesthetic injections in the facial nerves and a high powered CO2 laser to remodel the face in one session. While there are fewer sessions, the recovery period is more extensive, as skin will be raw and oozing directly afterward.

Incisions: Also known as “subcision,” this method is used to break up fibrous bands that are pulling the skin in different directions to create a “rolling” scar. This method can cause some bleeding and bruising. While it works well, the treatment course can be complicated by the possibility of forming nodules beneath the skin, causing bumps. These nodules can, however, be treated with intra-lesional cortisone injections.

Kenalog: Keloid scars are best treated with a steroid injection (or multiple injections) to decrease the body’s overzealous response to scar formation. Another option is to physically cut out the keloid and suture the skin back together, but this could potentially result in yet another keloid.

By visiting your physician, he or she can help you make a treatment plan that addresses the specific type of acne damage you have. While you may not be able to erase all evidence, a drastic reduction in the visibility of these scars is absolutely possible with todays dermatologic and cosmetic technology and minor surgical procedures.

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