Acne Scars

Millions of people have scars from the long-lasting inflammation caused by acne. Acne scars occur most frequently in those with moderate to severe acne. Types of acne scars include icepick, boxcar, rolling, and hypertrophic scars.

Many treatment options are available, including topical medications (for superficial scars), dermabrasion, microdermabrasion, excision and punch replacement graft, subcision, dermal fillers, chemical peels, and laser resurfacing, and fractional lasers. In most cases, improvement can be seen in 4 to 6 weeks. Treatments may be combined in some cases.

There are many different types of acne scars. Deep pits that develop following an acne lesion are called “ice pick scars,” and are a classic sign of acne scarring. Angular scars (boxcar scars) usually occur on the temple and cheeks, and can be either superficial or deep. Scars that give the skin an undulating appearance are known as “rolling scars.” Many patients require a combination of treatments for the best results.

Treatment Types

• Surgical scar excision by punch biopsy or suture surgery.
• Laser Surgery: Extensive laser resurfacing, regional resurfacing with CO2 and/or Erbium:YAG Lasers, or non-ablative lasers including: Smoothbeam Laser, Starlux Fractional Resurfacing.
• Dermabrasion: mechanical rotary device to surgically plane the skin.
• Topical treatments including retinoids (Retin-A) and topical antibiotics as adjunctive therapies.

Superficial scars, those that affect only the epidermis and the uppermost layers of the dermis, can appear as reddish, or more commonly brownish, blemishes of the skin. If protected from the sun, most of these superficial scars/discolorations will fade significantly or completely within three to 18 months.

In some individuals, particularly those with olive-toned or darker skin, nightly home applications of tretinoin (Retin A), coupled with morning applications of a noncomedogenic combination of alpha hydroxyacid and SPF 15 sunscreen may be sufficient to improve the appearance of these scars after several weeks to months of continued use.

Others may additionally benefit from an in-office series of light glycolic acid or beta hydroxyacid peels or microdermabrasion to hasten the fading of the lesions and to promote collagen synthesis. For more extensive superficial scarring, where scores of lesions may be present, dermasanding or laser resurfacing may be needed.

Laser Resurfacing

Laser resurfacing is one of the most useful techniques in the treatment of acne scarring. With this procedure, thin layers of skin are removed, layer after layer, until the scars improve or disappear. At the same time the skin tightens to help smooth out the scars. Laser resurfacing is often combined with one or several other treatments for acne scars, and this combination approach consistently yields superior results compared to other therapies. In most cases, the surgical treatment of scars is completed prior to laser resurfacing.

The laser treatment is scheduled 6 to 12 weeks after the last surgical treatment to allow your skin time to heal and remodel. Laser resurfacing is superb for treating shallow boxcar scars, as well as for smoothing and tightening scars that have been treated with other surgical modalities such as subcision and excision. For individuals who are interested in laser treatment of acne scars, but are interested in a less invasive procedure, non-ablative resurfacing with either the Cool Touch, Smooth Beam or Fraxel lasers offers the potential for significant improvement.

Additional Resources

- Acne Scars (American Academy of Dermatology)