Scarring is a common side effect of acne. The scars are the result of the wounds created by acne inflammation.
Acne scars are usually permanent, although they often fade with time.
Types of Acne Scars
The most common type is the deep, narrow “ice pick” scar. “Rolling” acne scars, on the other hand, are shallow and wave-like. “Boxcar” scars have sharper, well-defined edges; they look similar to chickenpox scars. All of these scars are indentions in the skin, but acne can also create thick, red hypertrophic scars, which appear above rather than below the skin’s surface.
Acne inflammations can leave behind skin discolorations that give the appearance of scarring. These discolorations can be white, pink, or purple, and are more common in people with darker-hued skin.
Several new advances, particularly in laser technology, have made treating acne scarring and discolorations much safer and more effective.
- Laser Therapy
These treatments use laser energy to remove the scar-damaged top layer of skin. There are two basic types of laser treatments: ablative and non-ablative. Ablative lasers, such as the carbon dioxide (CO2) and eribium:YAG lasers, essentially burn off the scarred area to a controlled depth. Recovery can take two weeks or more. Non-ablative lasers send laser energy beneath the skin without damaging its surface. The energy encourages the remodeling of collagen, which then helps to minimize the indented appearance of the scar. The effects are not as dramatic as with ablative treatments, but the recovery time is much shorter.
This treatment uses a motorized wire wheel or a burr imbedded with diamond crystals to scrape away the skin to a level where a scar becomes less visible. It’s done under local anesthesia and requires about a two-week home recovery.
Dermabrasion should not be confused with microdermabrasion, which can improve superficial skin imperfections and enhance the skin’s overall texture and tone, but which can’t help with the deep scarring associated with acne. Microdermabrasion can, however, help fade some of the skin discoloration caused by acne.
- Chemical peels
Mild chemical peels (those using alpha hydroxy or beta hydroxy acid) may help a bit with minimizing skin discolorations caused by acne, but they do not penetrate deeply enough to impact acne scars. Even medium chemical peels have limited effectiveness. Deep phenol peels can help remove acne scars, but these are major medical treatments and are used only in very limited situations and on fair skin.
- Dermal fillers
Various types of dermal fillers can be injected into the scar to raise it to the level of the surrounding skin. This is only a temporary solution, however, as the fillers eventually break down.
- Punch techniques
Used primarily on “ice pick” scars, the punch excision technique removes the scar with a special device designed for this purpose. The area is then sutured and left to heal. Any scar produced by the procedure is very small and gradually fades away.
The punch elevation technique, which is use mainly with boxcar scars, is similar, except that the excised scar tissue is sutured back to fill in the indention and make it level with the surrounding skin.
- Punch techniques