Acne Scar Treatment

While acne sores are bad enough, the scars they leave behind can seem like a permanent, long-lasting nightmare. Scars can rob individuals of their self-esteem and cause a great deal of distress for those suffering with them, affecting much more than their daily interactions with people. As hard to believe as it may be for those with blemish-free faces, stress from acne scarring can destroy a person’s self-esteem, with detrimental effects on their professional, romantic, and social lives.

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Medically Reviewed by Dr. Andrew Frankel, MDLast Reviewed 09.13.2018

Summary

Perhaps one of the most important aspect of one’s appearance is the face. Our faces play a large role in how we communicate, express ourselves, and even how we evaluate each other. When acne strikes, however, our faces can quickly turn from assets into burdens to hide from the rest of our world—whether it’s a single sore or a full-on flare-up.

Fortunately, modern advancements in cosmetic medicine have made it possible to rid patients of acne and acne scarring. In this article, we’ll cover what you should know about your treatment options and their capability to change the reality of your acne scars.

Overview

Acne is a common skin condition that’s characterized by red pimples on the skin, especially on the face, created by inflamed or infected sebaceous glands. It’s prevalent mainly among adolescents but may also be present in some adults. After acne has healed, it can leave behind very visible scarring; some studies suggest that up to ninety-five percent of those who suffer from acne vulgaris will experience at least some scarring.

The problem of acne is certainly not a new one. In fact, the background of acne reaches back to the dawn of recorded history. There are records that several, ancient Egyptian pharaohs suffered from it. And 2000 years ago, in Rome, bathing in sulfur mineral waters was among one of the few treatments specifically cited as a way that the people of the past dealt with the inflamed bumps.

The good news is that with advancements in medicine and cosmetic procedures, there are now many treatments available to address the problem of acne scarring. If you’re interested in having one of these procedures done, this guide will help you learn more about the process so that you can determine whether acne scar treatment is the right choice for you.

What Causes Acne Scars?

When acne breakouts penetrate deep into the skin, they damage both the skin and the tissue beneath it. As the acne clears, the body tries to repair this damage.

During the healing process, the body produces collagen—a substance that gives the skin support. If the body produces too little or too much collagen, the skin will scar. There are two types of acne scars, and the kind you’ll have will depend on the amount of collagen your body makes.

There are two main types of scars, caused either by a loss of tissue, or an excess of tissue:

Depressed Acne Scars (hypertrophic) - This type of scarring occurs when the body produces an insufficient amount of collagen, resulting in small, cave-like depressions in the skin as it heals.

Raised (or atrophic) Acne Scars - If the body produces too much collagen as it tries to heal, a raised acne scar will develop.

Within these two categories, there are three different types of acne scars. These are known as icepick scars, boxcar scars, and rolling scars.

Icepick Scars: This type of depressed acne scarring is characterized by its long, thin, needle-like marks, and are widely known as some of the hardest acne scars to treat.

Boxcar Scars: Boxcar acne scars resemble chicken pox scarring, with sunken-in indentation marks that are typically broad and rounded.

Rolling Scars: Rolling scars are caused by damage underneath the skin, and can be characterized by their signature rough, textured appearance or round, boxcar scar-like shapes.

What Types of Treatments for Acne Scars are There?

There are many different procedures to treat acne scars, depending on the type you have and the level of scarring present. In most cases where scarring is severe and the patient requires an intensive procedure to see significant results, doctors will recommend one of the following procedures.

Dermabrasion for Acne Scars Dermabrasion is the process of surgically scraping the top layers of skin and removing dead skin to help lessen the appearance of scars, wrinkles, pigmentation, and pre-cancerous lesions. In dermabrasion for acne scar surgery, your dermatologist or cosmetic surgeon will use the process to raise the scar, bringing it closer to the surface of the skin.

Dermabrasion takes around an hour to complete, and you may be placed under sedation with either local or general anesthesia for the pain. Some patients may receive their desired results after only one procedure, and others will require more than one procedure to eliminate or lessen the appearance of particularly severe scars.

Laser Skin Resurfacing for Acne Scars When a patient wants to reduce the appearance of widespread acne scarring, a dermatologist may recommend a laser resurfacing procedure. During resurfacing, layers of skin are removed to allow the body to produce new skin cells. To achieve the desired effect, doctors may use laser skin resurfacing along with chemical peels with glycolic acid, lactic acid or salicylic acid, dermabrasion, microdermabrasion, or a combination of these treatment methods for severe scarring.

There are many options for acne scar treatment using lasers. Laser treatments not only stimulates new collagen production, but also galvanizes the skin to generate healthier tissue and new cell turnover. For shallow to moderately shallow acne scarring and discoloration, fractional non-ablative lasers can offer patients results with little downtime. For more deep pitted scars, a more invasive fractional ablative laser will offer significant results in fewer treatments.

Dermal Fillers for Acne Scars A dermatologist may fill acne scars with collagen, the patient’s own fat, or another substance. Many fillers only give temporary results, which can last between 6 and 18 months. Some fillers are permanent. Skin fillers are suitable for treating a few depressed scars, but not icepick scars.

Dermal fillers are a great way to treat and potentially get rid of certain types of acne scars, particularly rolling and boxcar types. The type of dermal fillers your doctor chooses for your procedure will depend on a patient’s facial anatomy, scarring, and the results expected. In most cases, hyaluronic-based fillers like Juvederm, Restylane, and Belotero are preferred and used by plastic surgeons and dermatologists performing the procedure.

Subcision for Acne Scars Subcision is a procedure that treats depressed acne scars by inserting a needle under the skin, moving the needle back and forth to breakup the fibrotic strands of the acne scar, thereby releasing the tension of the scar and allowing the skin to rise.

Subcision is a relatively minor surgical procedure, performed by cosmetic surgeons to treat many types of depressed scars and wrinkles. Your doctor will insert a tri-beveled hypodermic needle through a puncture in the skin surface, moving its sharp edges under the skin in a fan-like pattern. These subcuticular cuts help to break up the acne scar tissue, releasing fibrotic bands that hold the scar underneath.

Repeated sittings are required for ideal cosmetic results. If many scars need subcision, few scars may be treated at a time, like on one cheek to avoid severe edema.

Less-Invasive Alternatives for Acne Scar Treatment

In lighter cases where scarring is not as severe, doctors often combine two or more non-invasive treatments together to achieve the ideal results for the patient. These non-invasive procedures that a dermatologist may use to treat depressed acne scars may include:

Skin Tightening- Dermatologists may use a technology known as radiofrequency to tighten the skin and make depressed acne scars less noticeable. Radiofrequency requires repeat appointments and some at-home care. After a radiofrequency treatment, patients may feel a burning sensation for a short time, and their skin often has a pinkish color for two to three days afterward. Skin tightening is good for treating depressed acne scars. Sometimes, skin tightening may also effectively treat deep icepick and boxcar scars.

Collagen-Induction Therapy- Also known as needling or micro-needling, to perform this procedure, a dermatologist moves a handheld needle-studded roller across the depressed acne scars. This punctures your skin. As your skin heals, it produces collagen. Many patients require multiple treatments and a period of months to see a noticeable change. Some swelling and bruising may accompany this method.

Electrodesiccation- This treatment involves the use of an electrical current, which is used to heat the skin. The high voltage current attacks unwanted skin cells from the surface, which removed damaged areas and reduces the appearance of acne scars. Additionally, electrodessication (when combined with another process called curettage) can also be used to aid in the removal of precancerous lesions and superficial skin cancer growths, and also benign tumors like skin tags, warts and granulomas. However, this treatment is not primarily meant as an effective treatment for acne scars when used alone. At the very least, it is ideal for shaping or reducing the edges of boxcar acne scars.

Treatment for Raised Acne Scars

Raised acne scars occur when too much scar tissue has formed as a result of the healing process. Raised scars can be altered to appear less severe or even surgically removed in some cases. This type of scarring is usually easier to treat than deep, depressed scars.

The treatments that a dermatologist may use to treat raised acne scars include:

Injections- Injecting medicine directly into certain scars can soften and flatten them. Many patients receive injections of corticosteroids. A chemotherapy medicine known as fluorouracil (5-FU) can also be effective in treating raised acne scars. Getting the best results often requires several repeat visits over a period of a few weeks. This type of treatment is often recommended for those with raised, painful scarring.

Laser Therapy- Lasers and other light therapies, like pulsed dye laser (PDL) are often used effectively in the treatment of acne scarring. In particular, pulsed dye laser therapy can help to flatten raised scars and reduce their appearance.

Cryosurgery- This treatment freezes the scar tissue and causes it to die and gradually fall off. To improve the results, dermatologists often recommend a series of cryotherapy sessions and corticosteroid injections. The main drawback with cryotherapy is that it can cause permanent light spots to form on the treated skin. It can effectively diminish raised scars in people who have lighter skin, but is not usually recommended for darker skin tones.

Scar Creams and Gels- Often available over-the-counter and without a prescription, scar creams and gels can sometimes help to reduce the itch and discomfort as well as shrink, flatten, and fade raised acne scars. While creams and gels may be good options for reducing scar size and discomfort, none of these are likely to eliminate a raised scar.

Why Should I Get Acne Scar Treatment?

Many people choose to have acne scar treatment for physical, emotional and social reasons. It can effectively improve appearance, enhance self-esteem and promote better skin health. If you feel that your acne scars affect your everyday life and limit your opportunities in areas like socializing, dating, or your career, acne scar treatment could be appropriate for you.

It’s best to consult with your doctor or a certified dermatologist in your area. Acquiring opinions from multiple specialists near you may be helpful in determining your options and the best possible prices for pursuing them.

What Benefits Can I Expect From Having Acne Scar Treatment?

The goal of acne scar treatment is to diminish the appearance of acne scars and dark spots and to improve skin tone. Many of these treatments, from dermabrasion to laser skin resurfacing and others can effectively reduce the visibility of acne scarring, especially over time. This can result in the patient gaining more self-esteem and having an improved appearance.

Who Is the Ideal Candidate for Acne Scar Treatment?

As there are many options available for treating acne scars, the best way to determine if any one type of treatment is suitable for you and your unique situation is to consult an experienced dermatologist. They will assess your skin and pay close attention to your scars to help you to decide what treatment, if any, is most appropriate.

The best candidates for acne scar treatment will have realistic expectations about what to expect after their procedure. This can be gained from a thorough consultation by your doctor, who will provide you with plenty of information about your options, what benefits you might have from each one of them, and what you can reasonably expect to achieve after the procedure is finished.

Will I Be Put Under Anesthesia During My Acne Scar Treatment?

Whether or not you are put under anesthesia—and what kind anesthesia you’re given—will depend on the treatment you receive.

In most cases, medication is often provided before acne scar treatments to help the patient relax during the procedure and to minimize any pain that might be felt throughout. Topical anesthetics are also commonly used to numb small treatment areas in many procedures, including dermal skin fillers, laser skin resurfacing, and subcision treatments.

For more invasive procedures, including more intensive resurfacing treatments like dermabrasion, a nerve block (general or local anesthesia), or conscious sedation may be utilized.

How Will I Prepare for My Acne Scar Treatment?

Preparing for your treatment will depend on the type of procedure you’re having. Your doctor will let you know what you should do to be ready, and what you can do beforehand to ensure your safety and enhance the quality of your results.

In general, most procedures require patients to avoid sun exposure for a couple of weeks before treatment. If you smoke, your doctor will likely recommend that you stop from two to four weeks prior to your scheduled procedure. Your doctor might recommend stopping blood thinners and any medications that cause the skin to darken, and might prescribe an antiviral medication and an oral antibiotic around the time of the procedure to help prevent infection.

You may also be prescribed the use of a retinoid cream for a few weeks before treatment to promote healing.

It’s also best to avoid irritating inflamed skin. Overly washing or scrubbing scarred areas can further reduce skin elasticity and heighten the appearance of the scar. Picking at scars should also be avoided. Bacteria from unwashed fingers and nails can increase the risk of additional cysts forming, sometimes leading to the development of a larger scar.

What Should I Expect After Surgery?

This will depend on the type of treatment that you’re given, but skin usually takes time to recover from acne scar treatments. Results may not be visible immediately, and the appearance of scars will generally improve over the next weeks or months after your procedure.

Of all treatments, dermabrasion is the most intensive and has the lengthiest recovery period, which could last between one and six weeks, depending on the size of the area treated. Laser skin resurfacing has an average recovery period of anywhere from a few days to three weeks, depending on the size of the area treated.

It’s not uncommon to experience some pain, swelling, itching, and redness after cosmetic procedures. You should consult with your dermatologist about what to expect after your treatment, and how to best prepare for your recovery process afterward. Following the skincare advice you’re given before and after your visit will aid the recovery process and help you heal faster, and will also enhance the quality of your results.

Are There Any Potential Side Effects or Complications From Acne Scar Treatment?

Side effects from acne scar treatment include swelling, discomfort, itching, and redness. Generally, side effects will be mild and only moderately uncomfortable at worst.

Depending on the treatment and patient skin type, rare side effects and complications can occur including infection, scarring, hyperpigmentation, hematoma, or injury to nerves and blood vessel damage.

Some patients react differently to various medicine-based methods, so patients are advised to share their complete medical history with their medical professional before having any kind of procedure. Your doctor will be able to determine your risk for potential side effects and how to best prevent them from occurring.

How Much Does Acne Scar Treatment Cost?

The cost of treatment will vary greatly depending on a variety of factors, such as the type of procedure, the area being treated and the severity of the scars.

Among the most expensive procedures for acne scar treatment, dermabrasion, laser skin resurfacing, and dermal skin fillers top the list. Of those treatments, dermabrasion has the highest price range, between $1100 - $4000 USD. Laser skin resurfacing can cost anywhere between $750 - $3500 USD, and dermal skin fillers have an estimated price range from $300 to $3000 USD, per treatment. In all of these cases, the cost will vary depending on the size of the area being treated, and the technique being used.

For the most accurate estimate possible, visit your dermatologist or a cosmetic surgery professional to learn what kind of acne scar treatment you need and what it might cost for you. There are many options available, and your doctor will be able to suggest the most appropriate ones that will help your case and offer advice on which ones will best suit your budget.

Are Results Permanent or Temporary?

The type of treatment you choose will determine whether your results are temporary or permanent. Dermabrasion, for example, offers potentially permanent results. This means that this technique can remove or lessen the visibility of scars, but results may be affected by the natural aging of the skin.

Similarly, laser skin resurfacing offers potentially permanent results, depending on the laser method used and the number of treatments completed. Results are permanent, but will be affected by the natural aging process and if proper skin care is not followed after treatment such as avoiding sun exposure.

In other treatments like subcision and dermal skin filler procedures, results are usually permanent but affected by other factors, including improper aftercare, and failure to complete the proper amount of maintenance treatments.

Conclusion: The Pros and Cons of Acne Scar Treatment

Acne scars can be frustrating, but there are many treatments to choose from to reduce this frustration. The drawbacks of such treatments are that they often can’t completely remove scarring and that there can be some side effects associated with them.

With the help of a good dermatologist, however, you can find the best way to combat your acne scars both safely and effectively. The results of such treatment can dramatically improve your skin tone and appearance, giving you the confidence and self-esteem that you deserve to have.

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