Acne Scar Treatment

An acne scar treatment is for scars on the skin that are the result of injury and tissue repair. The damaged tissue is healed, but it won't always look like it did before. In people with severe forms of inflammatory acne, scarring will happen more frequently. Sometimes its hereditary too. Acne scars may fade over time, or they could be a lifelong reminder of issues you've had with acne.

To do your best to avoid acne scars, prevention of acne is your best bet. I know, easier said than done, right? Treat acne early and often, and for as long as it lasts. If you can prevent that inflammation, you'll have a much better chance at avoiding acne scars. I know it's tough to go out in public with acne. It's even worse when it forms during the day. Sometimes I'll take a break and go look in the mirror and poof! There's a new blemish on my face that wasn't there that morning. I hate it when that happens.

Whatever you do, do not pick at or squeeze blemishes! All this does is damage the surrounding tissue and could possibly lead to a permanent scar.

What works for me is applying anti-blemish cream, just patting it on to the affected area. That helps it to diminish and it's gone before too long. I will also sometimes disguise it with concealer or foundation. Doesn't always work, but at least it's not sticking out like a sore thumb.


Keep Healthy

It also pays to stay healthy. Healthy skin has the ability to repair damage faster and better. Make sure you're drinking enough plain water, getting enough sleep and applying sunscreen when you go outdoors. Stick to organic foods as much as possible and avoid processed foods. Also, if you're a smoker it's a good idea to quit. Smoking contributes to free radical damage causing your skin to age faster, and making it vulnerable to acne scarring.


Scar Types

After blemishes heal they will leave a reddish-colored spot behind. This is what's called a macule and it will fade. A macule is the last part of an acne lesion. It may take six months, but it will go away and it won't leave a permanent acne scar.

Another “pseudo scar” is called post-inflammatory hyperpigmentation, which mostly occurs in Latino, African-American and Asian peoples. It's a darkening of the skin where the acne lesion is healing. These dark spots can last for up to a year and a half.

Real acne scars will either be a) from loss of tissue or b) from increased tissue formation (hypertrophic). Hypertrophic, otherwise known as keloid scars (see photo), are less common and seem to be hereditary. They can be found in mainly the same ethnic groups listed above. What happens is the skin cells respond to injury by overproducing collagen, and it turns into shiny, firm, lumpy masses, usually along the jawline and on the person's chest or back. It will often grow larger than the original wound. Cortisone creams or injections are used on these types of acne scars.

Keloid scarKeloid Scar

image © Jeridu | Dreamstime.com


The acne scars that are from loss of tissue (atrophic) are way more common, and come in many different varieties.

Soft or “rolling” acne scars will have gently sloping rolled edges that merge with the surrounding skin and are a result of fibrous bands of tissue developing between the skin and the subcutaneous tissue below. These bands pull on the epidermis and anchor it to deeper structures of the skin, creating a rolling appearance.

Ice pick acne scars are deep, very narrow, sharp scars that extend into the dermis and make the skin appear as if it has been pierced by an ice pick or sharp instrument. Most often found on the cheeks, ice pick scars appear to make a small, deep "hole" in the skin which may look like a large, open pore. This type of scar will develop after an infection from a cyst or other deep inflamed blemish makes its way to the skin's surface, destroying skin tissue and leaving a long scar. Ice pick scars are almost always too deep to be corrected with skin treatments like microdermabrasion or laser resurfacing.

Boxcar acne scars may evolve from ice pick scars into boxcar-type (depressed fibrotic) scars. They usually occur on the temple and cheeks, and can be either superficial or deep, depending on the amount of tissue lost. Boxcar scars are round or oval depressions that have steep vertical sides, similar to chicken pox scars. Unlike ice pick scars they do not taper to a point at the base. They are wider than ice pick scars and have a pitted appearance.

Acne Scar Treatments

Most people recover from acne with no permanent scarring, but some are left with disfiguring acne scars. There are topical skincare products and medications that can improve minor scars, and the more severe ones can be treated with a combination of surgical procedures and skin resurfacing.

Subcision or subcutaneous incision is an acne scar treatment used for breaking up the fibrous bands that lead to rolling scars. Its performed under local anesthesia. Typically, a beveled needle is inserted under the skin, parallel to the skin's surface. The needle is gently moved back and forth between the dermis and the subcutaneous tissue. This motion cuts the tethering bands. You may experience bruising which fades after about a week, as well as bleeding and the formation of subcutaneous nodules.

Laser Resurfacing is an acne scar treatment best for shallow skin imperfections, though it's actually a popular skincare treatment for many skin defects. The two main types of lasers used in laser resurfacing acne scar treatments are the carbon dioxide and YAG lasers, which basically work by pretty much burning the top layers of skin to an exact depth. The burned skin goes through a healing process, and the burned skin layers are replaced by new skin. The success of this procedure has a lot to do with correct post-operative skincare.

Microdermabrasion is best used on shallow skin imperfections and usually requires multiple sessions to achieve the desired effect.

Punch Excision is used on deep scars such as ice pick and deep boxcar scars. This acne scar treatment utilizes a punch biopsy tool which is basically a round, sharp tool that comes in different diameters. The tool size is matched to the size of the scar to include the scar's walls. Local anesthesia is administered, the scar is removed with the punch tool and the skin's edges are stitched together. This will form a scar which eventually fades and may not be noticeable. If it is, a skin resurfacing treatment can be tried.

The punch grafting acne scar treatment uses the same method as punch excision, but instead of stitching the edges of the skin together, the gap is filled with a skin graft, usually with skin from behind the ear. While a color and texture difference may be noticeable, a skin resurfacing acne scar treatment can be used about 4-6 weeks after the grafting procedure to correct any flaws.

Punch Elevation is a method of surgically correcting acne scars like deep boxcar scars with sharp edges and normal bases. The same punch tool mentioned above is used to remove the base of the scar, but this time leaving the walls of the scar intact. The excised base is then elevated to the skin's surface and attached with either stitches or skin glue. This method lessens the risk of scarring and color or texture differences from a graft replacement.

Dermal Fillers is an acne scar treatment where fillers like fat or collagen can be injected into acne scars to raise the surface of the skin and give a smoother look. Further injections are necessary, since the injection does not permanently correct acne scars.

People will experience different types of acne scars, and each person is left with different facial conditions. No single procedure is right for everyone. Each procedure has its own risks and benefits, and several procedures are normally combined to create the smoothest appearing skin. You must discuss with your dermatologist or cosmetic surgeon and decide on an acne scar treatment plan.

It might not be possible to restore your skin's appearance to its pre-acne state, but if your acne scars significantly affect your emotional well-being, it’s really worth considering.

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