Acne is a common condition that causes blocked pores, pimples, cysts and other lesions on the skin. While it is most common in teenagers, acne can affect people of all ages, most often appearing on the face, neck, chest, back, shoulders and upper arms.
For many patients, once acne lesions clear up or are removed, they leave behind discolorations and indentations on the skin. In many cases, acne can lead to scarring, especially if it is severe. Scars may form after acne has healed and cleared, and may vary from person to person. Some people may have small flat scars that are not very noticeable and others may suffer from more visible and indented scars on the face or affected area. Acne scarring is most often caused by larger acne lesions, such as cysts or nodules, which can swell and rupture, causing a break in the wall of the individual pore. Infected material from the inflamed lesion can spill out through this break and can affect the nearby healthy tissue, leading to the appearance of a scar.
Although not harmful, most people are bothered by the unattractive appearance of these scars and seek treatment to remove or significantly reduce their appearance.
Types of Acne Scars
Acne scars can vary in appearance and texture depending on the type and severity of the original acne lesions. Each type of acne scar may require a different type of treatment in order to repair the damaged areas of the skin and produce a smooth, clear appearance.
Atrophic Scars
Atrophic scars develop when there is a loss of tissue. Common types of atrophic scars include ice pick scars and boxcar scars. Ice pick scars are narrow indentations that form deep within the layers of the skin, creating an appearance that the skin has been punctured with an icepick. Boxcar scars are round depressions in the skin similar to chickenpox scars, which may be superficial or deep, depending on the severity of the pimple.
Hypertrophic Scars
Hypertrophic scars are caused when the body produces too much collagen as acne wounds heal, resulting in excessive amounts of raised tissue on the skin's surface. Also known as a rolling scars, hypertrophic scars create a wave-like appearance in the skin as a result of bands of tissue that develop deep within the skin and pull the epidermis down in certain spots.
Acne Scar Treatment
Treatment for acne scars depends on the type and severity of scarring, as well as each patient's individual skin and amount of correction desired. Treatment options may include:
Treatment for depressed (sunk-in) acne scars: These scars may be treated with a procedure or medication applied to the skin. To give you the best results, we may have to use more than one treatment. For example, we may recommend a combination of chemical peels and RF microneedling with PRP.
Treatment for depressed scars includes the following:
- Chemical peel: Applying a chemical peel to the skin helps the body produce more collagen and elastin. When the skin has more of both, depressed acne scars tend to be less noticeable.
Peels are available in strengths ranging from mild to strong. We will determine which strength best meets your needs. Mild and medium peels often require more than one treatment session. For example, if you have a mild peel, you may need 3 treatments, which are given every 4 weeks.
Before getting a peel, we may give you instructions for pre-peel priming. It can help you get the best results and reduce possible side effects. Pre-peel priming can include taking an antiviral medication or applying a retinoid.
You’ll also need to protect your skin from the sun before getting a chemical peel. Doing so helps prevent discolored skin from developing after treatment. Be sure to follow all our pre-peel priming instructions. - Fillers: This treatment adds volume to depressed scars. Fillers can also help your body produce more collagen and elastin to fill in the scars. We use different fillers, which last for varying amounts of time.Most fillers give temporary results, ranging from 9 months to a year.
Most fillers require a series of treatments, so you may need more than one office visit for this treatment. To retain your results, you’ll also need touch-up visits. - Laser treatment: We use lasers to resurface skin with acne scars. As your skin heals after laser resurfacing, it produces collagen and elastin, which can diminish the appearance of scars. We may also use a laser to contour skin around acne scars, which can also diminish the appearance of scarring.
Some lasers require more treatment sessions than others. - Medication applied to the skin: If you have mild acne scarring, a retinoid or salicylic acid can make scarring less noticeable.
- Microneedling: During this procedure, we use tiny needles to puncture the skin with acne scars. Puncturing the skin causes the body to produce new collagen and elastin. Also called “collagen induction therapy,” the new collagen helps diminish acne scars.
Microneedling is safe for all skin tones.
To improve the results that patients see, microneedling is often used along with another treatment like radiofrequency, chemical peeling, or platelet-rich plasma. - Platelet-rich plasma (PRP): We may use this treatment to enhance the results of another treatment like microneedling. PRP involves having a small amount of your blood drawn. This blood is placed into a machine that separates the blood so that your dermatologist can use your platelets.
We will inject your platelets into the treated area. Studies show that using PRP along with another treatment like microneedling can lead to less visible scarring. - Radiofrequency: This procedure uses radiofrequency waves to help your skin produce collagen and elastin. When your skin has more of these, acne scars are less noticeable.
A type of radiofrequency called radiofrequency microneedling combines radiofrequency with microneedling, a procedure that punctures your skin with tiny needles. Using both can produce less noticeable acne scars than either radiofrequency or microneedling alone.
Both radiofrequency and radiofrequency microneedling are safe for all skin tones.
Treatment for raised acne scars: When treating depressed scars, the goal is to get the body to produce more collagen to fill in the depressed areas. Raised scars develop when the body produces too much collagen, so they require different treatment.
To diminish raised acne scars called hypertrophic scars, we may recommend laser treatments, injections of corticosteroids or another medication, or applying a prescription medication to the scar(s).
Preventing Acne Scars
The most effective way to prevent acne scars from developing is to stop the lesions that lead to scarring from forming. It is also important for patients to avoid picking or popping active lesions, as this can lead to infection and increase the risk of scarring. Picking at scabs should also be avoided to allow natural healing to occur without interruption. Sun exposure can lead to further damage of the skin and may delay healing of scars and lesions and should be avoided as much as possible to maintain the health of the skin.
Some patients are naturally prone to developing scars from acne and will not be able to prevent these scars from occurring. Fortunately, there are many treatments available to reduce the appearance of acne scars and revitalize the skin.