Treatment of Acne Scars

Treating acne scars (as with treating any kind of scars) is difficult.  There are no cures or miracle treatments for acne scars.  Depending on the type of acne scars you have and how long they have been present, you may consider one of the treatments outlined below.  Contact your local acne physician to find out more about acne and acne scar treatment options.

Prevention.  The best way to avoid acne scarring is acne prevention.  If you have acne and it is causing scarring, get proper treatment for your acne right away to prevent further scarring.

Acne Scar Treatment Options:

Treatments for hyperpigmentated acne scars.  Post inflammatory pigmentation (or post traumatic hyperpgimentation) refers to the pigmentation changes that occur during the healing process after an acne lesion becomes infected.  In lighter skinned individuals the inflammatory pigmentation response is usually redness or edema at the site of the acne infection.  In darker skinned individuals, brown or black spots may appear at and/or around the acne lesion.  Often this pigmentation will resolve on it's own, but for some it can takes weeks, months or years to do so.  The hyperpgimentation is exacerbated by picking the face and creating scabs.  Prescription medications, lasers, topical skin care products and behavioral changes can help facilitate the healing process and get rid of pigmented acne scars.

• Using prescription tretinoin (Retin-A, Renova, Avita) speeds up the skin's remodeling process (skin renewal speeds up) to eliminate post-inflammatory changes more quickly.
• Appropriate formulations of Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) also speed the skin's remodeling process.
• Prescription and non-prescription bleaching agents such as hydroquinone can speed the process of removing hyperpigmentation.
• Lasers such as the Nd:Yag laser (1064 nm) and pulse dye lasers (585 nm) are designed to diminish or remove brown and red pigmentation, respectively.
• Wearing sunscreen and staying out of the sun will speed the healing time.  Unprotected exposure to the sun causes more skin damage and delays healing.
• Picking at scabs should be avoided at all costs. Scabs form to protect the healing process that is going on underneath the skin. Pulling a scab off before it is ready interferes with the healing and remodeling process, prolonging the time that post-inflammatory changes will be visible.

Collagen injections. In this acne scar treatment, collagen, the skin's natural building block is injected under the skin to stretch or fill out superficial and deep soft scars.  The cosmetic benefit from collagen injections usually lasts 3 to 6 months, and additional collagen injections can be done as needed to lessen and maintain the depth of the scar.  Typically, collagen treatment does not work as well for ice-pick scars and keloids but can work well for soft acne scars. 

Fat transfer.   In this acne scar treatment fat is taken from another site on the body and injected into the acne scar.  The fat is injected beneath the surface of the skin to elevate depressed (atrophic) scars.  Because the fat is reabsorbed into the skin over a period of 6 to 18 months, the procedure is usually repeated. Longer lasting results may be achieved with multiple fat-transfer procedures.  Autologous (from your own body) fat transfer is usually used to correct deep contour defects caused by scarring from cystic acne. 

Laser Treatment.  In this acne scar treatment, one of several different lasers may be used to remove hyperpigmentation and remodel skin texture.  CO2, Erbium and nonablative lasers are typically used to resurface the skin.  Ablative lasers such as the CO2 and Erbium lasers stimulate new collagen growth by removing the uppermost layers of the skin.  Depending on the depth of CO2 resurfacing, general anesthesia may also be required.  Erbium resurfacing dowtime is minimal and non-ablative lasers work to stimulate collagen without removing skin layers, therby reducing downtime.  All of these lasers create small thermal injuries, and new collagen develops to fill the acne scars as the skin tissue heals.  Pulse dye lasers and Nd:Yg lasers are used to reduce red and brown hyperpigmentation.  Resurfacing with CO2 and Erbium lasers for darker skinned patients may cause hyperpgimentation.

Dermabrasion.   In this acne scar treatment, a high-speed brush is used to remove surface layers of skin.  It is one of the more effective acne scar treatments for modifying the contour of older, fibrous scars.  During the treatment, superficial scars may be removed altogether, and deeper scars may be reduced in depth.  In recent years, the treatment has become less common because of the long down time and the requirement for general anesthesia.  Dermabrasion may not work for all types of scars.  For example, if ice pick scars are deeper below the surface of the skin, it can actually make them more noticeable.  In darker-skinned patients, there is a risk that hyperpigmentation may occur in response to the treatment.

Microdermabrasion.  In this acne scar treatment, a high-speed brush, vibrating head or high speed air chamber is used to resurface the skin.  With air chambers, microdermabrasion uses aluminum oxide crystals passing through a vacuum tube to remove the outermost layers from the surface of the skin. Because only the very surface cells are removed, wound is created, and no healing is required. Multiple procedures are often required, and typcally this procedure is only used for the most superficial of acne scars..

Punch Surgery.  In this acne scar treatment, ice-pick scars may be removed by "punch" excisions.  In this process each individual scar is removed and replaced with a healthy graft (or punch) of skin tisuue from another area of the body.  During the procedure each acne scar is excised down to the layer of subcutaneous fat.  The resulting hole is repaired with a punch skin graft, usually from another area of the scalp.  Punch surgery may work well to fill the holes created by icepick scars, but pigmentation issues can remain fter surgery and downtime is required for healing. 

Subcision.  In this acne scar treatment, a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar.  It is used with deeper fibrotic such as ice pick scars.  Because the process is an invasive surgical procedure, subcision is tyically reserved for very deep, aged scars.

Skin grafting.  In this acne scar treatment, flat skin grafts from other areas of the body are used to cover or repair acne scars.  Grafting may be necessary under certain conditions such as when dermabrasion uncovers dermal tunnels (also called sinus tracts) caused by inflammatory reactions to sebum and bacteria in sebaceous follicles.

Keloid Treatment.   In this acne scar treatment, scars may be treated by injecting steroids into the skin around the keloid.  Topical retinoic acid may also be applied directly to the surface of the keloid.  Laser treatment may also be used to reduce the coloration and texture of keloid scars.