Has Your Acne Left Scars?
Learn About Acne Scar Treatment Options
Acne affects an estimated 99% of people - mostly teenagers and young adults - at some point in their lives. Although acne is temporary,
lasting from a few months to a few years, early therapy is necessary to
prevent scarring and dyspigmentation, which, untreated, can persist for
If acne scarring has occurred, several treatments are
available to improve the appearance of your skin. These include skin
filler substances, laser phototherapy and conventional surgery. These
can be used alone or in combination.
Classification of types of scarring
The first step in selecting the appropriate treatment for scarring
is for your physician to define the type of acne scars you have. For
complete information about scarring, see acne scars
The three types of acne scars are:
- Ice-pick: Ice-pick scars are 1-2 mm in diameter,
Rolling scars are caused by abnormal fibrous bands and are usually
wider than 4 to 5 mm. Rolling scars are so-called because of the
appearance they give to the overlying skin
- Boxcar scars: Boxcar scars measure more than 3 mm in diameter and appear similar to post chicken pox scars.
Increased or decreased skin pigmentation and persistent reddening of
the skin also frequently occur following the development of acne.
After your doctor has completed a full examination of your skin, you
need to discuss the treatment options. Treatments include subcision
surgery, fillers such as Restylane® or Artecoll® and laser skin
resurfacing. For complete information about treatments, click on surgical treatments for acne.
Subcision is carried out under local anesthetic to cut the fibrous
bands in the deep skin layers. A compression dressing prevents
excessive bleeding following the procedure. This is often used for
Shallow boxcar scars can also be treated by subcision or punch grafting
and laser skin resurfacing. Treatment for deep boxcar scars includes a
combination of punch excision and punch elevation. Following
anesthesia, a punch-biopsy surgical instrument is used to remove the
scar. In addition, in most cases, punch grafting or punch elevation is
also needed for best results. Punch elevation involves lifting the
tissue instead of removing the scar. The tissue initially sits slightly
higher than the surrounding skin, but retracts as it heals to become
level with the remaining skin. Alternatively, skin resurfacing can be
achieved with chemical peels or laser techniques.
Laser skin resurfacing
Laser skin resurfacing removes, in a controlled way, the epidermal
layer of the skin and part of the underlying dermal layer. The healing
process results in smoother skin. Laser techniques should only be
carried out by experienced physicians.
Combination treatments using the surgical techniques described above
are often carried out with resurfacing therapies. Any surgical or laser
treatment should be delayed at least 6 to 12 months if you are taking
Accutane ®, otherwise complications with wound healing can occur.
A 30% to 60% improvement in scarring is considered a
reasonable result with these treatments. If you are considering
treatment for acne, remember that scar improvement takes time and
Mariusz J. Sapijaszko, MD FRCPC is the Director of the Western Canada
Dermatology Institute located in Edmonton, Alberta. He is also the
Clinical Assistant Professor at the Division of Dermatology, University
of Alberta, in Edmonton. His areas of expertise include cosmetic and
laser surgery. Learn more on his www.youthfulimage.com