Acne Scarring

• Atrophic or depressed scars are challenging to treat but there are several effective methods to improve these scars.
• 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.
• Icepick scars are sharp, pointy scars that deeply penetrate the skin. Treatment includes punch excision that removes the scar. This is a minor surgical procedure followed by a chemical peel or laser resurfacing to improve results.
• Boxcar acne scars are characterized by broad, rectangular depressions with sharply defined edges, and can be challenging to treat.
• Rolling scars are depressed scars. They are the most common type of acne scarring and look like small round or oval skin depressions. There are many options to improve this type of acne scarring.

Treatment options depend upon the type and severity of the scarring. Options include energy-based treatments like lasers, fractional radiofrequency, and intense pulsed light. Non- energy-based treatments include surgery, dermabrasion, microdermabrasion, microneedling, dermal fillers and chemical peels. The choice of treatment or combinations will also depend upon the risk for post – inflammatory hyperpigmentation.

• Acne scar surgery is a minor procedure to makes 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, are best for patients with widespread shallow depressed scars, and raised scars. Resurfacing can 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 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 height, redness and hardness of the acne scars.
• Skin fillers can be injected into depressed scars using a collagen- stimulating a 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.
• Platelet rich plasma injected into acne scars, or coupled with microneedling improves acne scarring more than microneedling alone. The growth factors released promote healing and stimulate collagen and elastin regrowth.
• Topical vitamin A creams (Retinol) 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. There are 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.