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Acne Scarring

Acne Scarring

What is acne scarring?

Acne scarring comes in many forms and can be improved by a variety of methods, depending on the type of scar.  It is essential to determine the type of scar to treat it properly.  Below is a brief definition of scar types and treatment options.  Our staff will discuss your options with you during the consultation.

Acne scarring types and treatments:

Ice Pick Scars – These scars are deep and narrow, with an abnormal base and walls.  There are two main methods of treatment.

  1. Punch excision – the area is numbed and the entire scar is removed with a circular tool. The area is then closed with a stitch that remains for 7 days.  Typically a test excision will be done before treating multiple areas to see how well you heal.  Patients with these types of acne scars inherently have issues with skin healing, so we want to make sure the skin will heal well after the punch excisions.
  2. Phenol spot scar peel – a special chemical can be used to remove the abnormal wall and base of the scar and allow the skin to heal in towards the surface. This is a two day procedure as the chemical is applied and left on overnight, then a special tool is used to clear away the scarred skin and healing bandages are placed on the area.  There is typically 7 days of healing of the scars with the phenol peel.

Box Car Scars –These scars look like chicken pox scars in that they are round or oval, with abnormal walls and bases.  They can be shallow or deep.  There are surgical and non surgical treatment options depending on depth and location.

  1. Punch excision – some scars are repaired by simply excising the deep scar and converting it into a line scar. This requires stitches for 7 days.
  2. Punch elevation – larger scars may need the base of the scar to be elevated and re-aligned with the surface of the skin. This requires stitches or a special adhesive for 7 days.
  3. Filler substances – some very superficial Box Car Scars can be improved with a filler placed underneath it. Hyaluronic Acids (Restylane and Juvederm) or Bellafill, a biostimulator can be used.  These stimulate collagen production and may last for months to years.
  4. Fraxel Dual 1550nm laser – this non-ablative fractionated laser can be used on most skin types to reduce shallow box car scarring on the face over a series of 4-5 treatments. There is mild swelling and pinkness for 3 days but no peeling of skin or surface healing required. 
  5. SmartXide DOT Fractional CO2 Resurfacing – the resurfacing procedure which tightens skin, replenishes collagen, and improves texture. Performed with topical anesthesia only, this treatment requires 3-6 days of downtime depending on intensity of treatment.
  6. Microneedling with PRP – using a variable depth microneedling pen, microscopic channels are created to produce new collagen in the skin. Platelet Rich Plasma is added during the treatment to provide skin growth factors for collagen production and rapid healing. Most patients complete a series of 5-7 monthly treatments. 

Rolling Scars – These scars appear worse in overhead lighting and disappear when the skin is stretched.  There are surgical and non surgical treatment options depending on the location.

  1. Subcision – a surgical process in which the skin is numbed and the tethering bands holding down the skin (and causing the depressions) are released with a special blade underneath the skin. There are no stitches, but there can be swelling and bruising for 7-10 days.
  2. Filler substances – Restylane, Juvederm and Bellafill can be used to elevate the depressed areas of rolling scars. They stimulate collagen production and can last for months to years.  Bellafill, a biostimulator, may last up to 5 years and slowly generates your own collagen.

Pink or Brown discolored “scars” – These are not true scars but temporary discolorations that can be faded with treatments and creams.

  1. Glycolic acids (Neocleanse Glycolic exfoliating cleanser, IS Clinical Active Serum, CCSD Purify AHA 5% Wash) and Retinoids (like Retin A, CCSD Reverse tretinoin, PCA Retinols, Tazorac, Epiduo, Differin) have been shown to fade pink spots over several months.
  2. Bleaching agents such as PCA intensive brightening cream, CCSD Correct Brightening Pads, CCSD Correct Hydroquinone 4% Lotion, CCSD Correct+ combo (4% HQ, Retinoic Acid, Steroid) and PCA Pigment Bar help to fade brown spots with nightly use.
  3. SilkPeel Microdermabrasion can help lighten pink (with clarity formulation/salicylic acid) or brown (with lightening formulation) spots with monthly treatments. 
  4. PCA peels help lighten pink (with TCA, Jessners, or resorcinol) and brown (with hydroquinone) spots with monthly treatments. These leave-on peels create exfoliation approximately 3-5 days after treatment. 
  5. Fraxel Dual 1927nm Laser can help lighten brown spots in a series of 2-3 treatments while providing some textural improvement to scars. 

All treatments for acne scars help to improve the scarring, but multiple treatments can be necessary.  It is impossible to remove a true scar completely.  Our staff will discuss which treatment options are best for you