Treatment of Acne Scars

Acne scars are difficult to treat because the defect is usually located deep within the dermis. A treatment method can only be successful if it reaches a depth equal to or greater than the depth of the scar being targeted. Even the best acne treatment methods fail to achieve 100% improvement. There is no such thing as “perfection” in this area of dermatology, but moderate and in some cases excellent improvement can be achieved.

Microdermabrasion is essentially a superficial skin peel. A machine uses little crystals to sandblast and buff the skin. Skin looks great after a microdermabrasion treatment. It is brighter and feels smoother. Microdermabrasion is an excellent skin treatment for patients with certain types of acne or pigmentation, but it is too superficial to make a real difference in your acne scars.

A punch excision is simply cutting out a scar and suturing the skin back together. It is useful for the treatment of ice pick scars or deep boxcar scars, as these do not respond to other treatments because of their depth. A “punch” excision uses a punch biopsy which is a round scalpel that is similar to a tiny cookie cutter. The result is usually a small line that replaces the hole of the acne scar. Hopefully the line will fade with time, however acne scarred skin often does not heal as well as normal skin and at times the skin does not stay together when the sutures are removed. It is wise to pick one or two test scars to try this technique and see how your skin heals before doing several.

Focal peeling involves the use of very high concentrations of trichloroacetic acid. These high concentrations are necessary to achieve the depth of treatment needed to affect boxcar or icepick acne scars, however it would be dangerous to peel someone’s entire face with these strong concentrations of acid. A toothpick-like applicator is used to apply the acid to one scar at a time. The acid destroys that scar, but all of the skin around it is left unaffected and therefore the treated area is able to heal from the outside in. Treatments are spaced one month apart and a scar may require 3 to 6 treatments.

Subcision is a simple surgical procedure used to treat rolling acne scars. Rolling scars are depressions in the skin that occur when the overlying skin is bound down or tethered to the underlying tissue. Subcision uses a needle that is inserted under the skin to cut the septa and release the skin. Typically, 2 to 6 sessions are required with a minimum interval of 1 month between each procedure. (We do not offer this treatment).

Laser resurfacing is basically a deep laser peel. Either an erbium or CO2 laser is used to ablate the skin on the entire face to a depth necessary to effectively treat the acne scars. This procedure is like an operation and is usually performed in an operating room under general anesthesia. The recovery often lasts two weeks, and carries a risk of infection and scarring. We do not perform erbium nor CO2 laser resurfacing because we do not feel that the benefit of this procedure justifies the risk. And now (for the last two years) we have an alternative that is safe and gives comparable results: fractional resurfacing (using the Fraxel laser).

Over the last two years, the Fraxel laser has become the “gold standard” for the treatment of acne scars. The concept of fractional resurfacing is explained at this link. Not all acne scars will respond well to this laser. The Fraxel can significantly improve rolling or shallow boxcar acne scars, or in general scars that are wider than they are deep. On the other hand it seems to do little for “ice-pick” scars. Click here to learn more about the concept of “fractional resurfacing”

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