Depressed Acne Scars: Effective Treatment Available

Most people who scar after the acne clears see soft, saucer-like depressions or pits on their skin. Sometimes the skin loses its underlying support and develops a wavy texture. As we age, these scars often become even more noticeable. The good news is that no one has to live with these scars.

3 Types of Depressed Acne Scars

   

Rolling acne scars

Boxcar acne scars

Rolling acne scars
These scars cause a wavy texture in the skin.

Boxcar acne scars
Often looking like large pores, boxcar scars cause boxlike walls to form on the skin.

   

Icepick acne scars

Rolling acne scars and boxcar acne scars - These photographs were published in the Journal of the American Academy of Dermatology, 2001 Jul; 45(1):109-17. Jacob CI, Dover JS, Kaminer MS. “Acne scarring: a classification system and review of treatment options.” Copyright Elsevier (2001).

Icepick acne scars - This photograph is used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.

Icepick acne scars
When these scars form, it looks like a tiny ice pick punctured the skin. Icepick scars leave deep pits with narrow openings.

Treatment Options for Depressed Acne Scars
Thanks to advances in medicine and technology, dermatologists have many treatment options for depressed acne scars. Advances have even lead to improvements in treatments that have been used for years. If you see a dermatologist for treatment, your own treatment plan may include one or more of the following:

Acne Scar Surgery
Acne scar surgery remains one of the most effective treatment options for treating depressed acne scars. With many types of acne scar surgery now available, dermatologist can remove, raise, fill, and even separate the scar tissue from the underlying skin.

The purpose of all acne scar surgery is to replace a large, deep scar with a smaller, flatter scar, which will be less noticeable and more likely to fade. After your skin heals from the surgery, your dermatologist may treat the smaller, flatter scar with laser skin resurfacing. This tends to make the scar even less noticeable.

Surgery is usually performed in a dermatologist’s office. Before the surgery, patients usually receive a local anesthesia (numbs only the area to be treated) or light sedation (you remain awake). The more common acne scar surgeries that dermatologists perform are:

  • Punch excision – A surgical instrument that looks like a round cookie cutter is used to remove the entire scar.

  • Punch elevation – After removing the scar, your dermatologist carefully raises the remaining tissue so that when it heals, it will be level with the rest of your skin.

  • Punch graft – After removing the scar, your own skin is used to fill the opening.

  • Subcutaneous incision – Your dermatologist uses a surgical probe to separate the scar tissue from the skin, which will raise the skin and flatten the scarred surface.

Before-and-After Pictures: Acne Scar Surgery

   

Before acne scar surgery

After acne scar surgery

Before - Man has rolling acne scars and boxcar acne scars.

After - 6 months after subcutaneous incision, a type of acne surgery used to raise the skin and flatten the surface.

   

These photographs were published in the Journal of the American Academy of Dermatology, 2001 Jul; 45(1):109-17. Jacob CI, Dover JS, Kaminer MS. “Acne scarring: a classification system and review of treatment options.” Copyright Elsevier (2001).

What you can expect after acne scar surgery: You may not see immediate improvement. There can be downtime. You may need to treat the wounds at home by changing bandages and soaking the treated skin. If you undergo subcutaneous incision, you may see bruising that can last for 1 or 2 weeks. Your dermatologist can tell you what you can expect and how many times you will need to return for treatment.

Laser Skin Resurfacing
Studies show that laser skin resurfacing can effectively treat depressed acne scars. In one such study, 158 patients aged 18 to 46 years old were treated with an ablative laser (creates a visible wound). For patients with icepick scars or shallow boxcar scars, the results were good to excellent. Even some patients with rolling scars had good results when dermatologists used a type of laser called the dual-mode laser. Deep boxcar scars showed least improvement, but a few patients with these scars had good results.

What you can expect after laser skin resurfacing: What you experience depends on the type of laser(s) used. Ablative lasers cause visible wounds, so you will have downtime. You also will need to care for the skin with soaks, antibiotic ointment, and dressings. Most people return to normal activities in about 2 weeks, which is when you will begin to see improvement. Many people continue to see improvements for up to 18 months.

Non-ablative lasers do not cause visible wounds. Many people can return to most activities immediately after treatment. To see improvement, a series of treatments is often necessary with these lasers.

Before-and-After Pictures: Acne Scar Surgery and Laser Skin Resurfacing
To deliver the best results, dermatologists often combine treatments for acne scars.

Before acne scar treatment

After acne scar treatment

Before - Woman has boxcar acne scars.

After - 3 months after treatment with acne scar surgery and laser skin resurfacing.

 

These photographs were published in the Journal of the American Academy of Dermatology, 2001 Jul; 45(1):109-17. Jacob CI, Dover JS, Kaminer MS. “Acne scarring: a classification system and review of treatment options.” Copyright Elsevier (2001).

Fillers
With improved, longer-lasting fillers, this treatment option has become very popular. People like that fillers can quickly diminish the appearance of acne scars. They also like that most fillers allow them to return to everyday activities immediately. The only drawback: Most fillers are temporary.

Your dermatologist may inject collagen, hyaluronic acid, PMMA (polymethylmethacrylate), your own fat, or another filler to plump up the scars. PMMA is the only permanent filler.

Most temporary fillers last about 3 to 6 months. When a dermatologist fills the scars with your own fat, the results can last 1 to 3 years, but there is downtime with this filler. To get the fat, your dermatologist will perform liposuction, which requires downtime.

What you can expect after treatment with a filler: While you can usually return to your everyday activities immediately, redness and swelling are normal. Some minor bruising also may be visible. To alleviate these, your dermatologist may recommend icing the area for 15 to 20 minutes before you leave. Makeup can usually be applied before you leave.

To avoid increased swelling and bruising, you should not exercise until the next day. You also will want to avoid touching the treated area for about 3 days, unless your dermatologist instructs otherwise.

Chemical Peels
For some people with acne scars, a chemical peel may be part of the treatment plan. If your dermatologist recommends a chemical peel, a high-potency acid will be applied to the skin to remove the top layer of skin. Very strong peels can reach even deeper into the skin.

What you can expect after a chemical peel: You can expect to see some redness. The amount of redness you see will depend on the type of peel used. It is important to know that a chemical will cause your skin to peel. Over the next 1 to 14 days, new skin will appear. If you had a deep or moderately deep peel, there will be some downtime.

All peels require some follow-up care. Protecting your skin from the sun after a chemical peel is necessary to help prevent unwanted side effects such as infection and scarring. You will be given specific instructions to follow, which will include everything from how to wash your skin to sun protection. It is important to follow these instructions.

Microdermabrasion
While not a leading treatment for acne scars, microdermabrasion can be effective for very mild acne scarring. During this procedure, a dermatologist uses a machine to remove the top surface layer of skin. With a series of microdermabrasion sessions, the skin can repair itself and shallow scars tend to become less noticeable.

Patients like that microdermabrasion does not require downtime and is considered painless.

What you can expect after microdermabrasion: After a microdermabrasion procedure, the treated skin may be pink or slightly red and swollen. If the skin is red and swollen, this should disappear within a day.

You will be given a skin-care plan that includes sun protection. Sun protection helps ensure the best possible results and reduces the risk of side effects.

Dermabrasion
While laser skin resurfacing has largely replaced dermabrasion, this remains an effective treatment option for some acne scars.

Dermabrasion, unlike the other treatments for acne scarring, is usually performed in a surgical center. Before the procedure, the skin will be cleansed and anesthetized (numbed). Usually a spray is used to anesthetize the area and a sedative is given. Sometimes a general anesthesia (puts the person to sleep) is used instead.

To perform dermabrasion, your dermatologist will move a handheld device back and forth or in a circular motion over the skin. An extremely sharp rotating blade will gradually remove the skin, which can remove the acne scars.

Dermabrasion must be performed carefully — one section at a time. If the entire face will be treated, the procedure lasts about 2 hours. To treat a smaller area, such as the upper lip, takes about 30 minutes. After the skin has been treated, particles from the device are rinsed away. Next compresses are applied to control the bleeding, and the wound is dressed.

What you can expect after dermabrasion: The treated skin will feel raw and sore, and you may be groggy. You will need 5 to 7 days to recover at home. Instructions for at-home care will include how to change the dressings and care for your skin. Following this at-home care is essential to prevent side effects and obtain the best possible results. If you have any questions, be sure to ask.

While new skin appears within 10 days, it is normal for the skin to continue improving for several months. During this time, you may notice slight redness and swelling.

Trust Your Dermatologist
If you want to know what treatment is best for your acne scars, be sure to talk with a dermatologist. There is a lot to consider when someone wants to treat acne scars. This includes the types of acne scars, what results you can expect, and your medical history. A dermatologist can create a treatment plan that is right for you.

References:
Jacob CI, Dover JS, Kaminer MS. “Acne scarring: a classification system and review of treatment options.” Journal of the American Academy of Dermatology July 2001; 45: 109-17.

Lee DH, Choi YS, Min SU et al. “Comparison of a 585-nm pulsed dye laser and a 1064-nm Nd:YAG laser for the treatment of acne scars: A randomized split-face clinical study.” Journal of the American Academy of Dermatology May 2009; 60: 801-7.

Rivera AE. “Acne scarring: a review and current treatment modalities.” Journal of the American Academy of Dermatology October 2008; 59: 659-76.


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Before treating acne scarring, several factors must be considered, including the type of scars, what results you expect, and your medical history.

 
 
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Page last updated  9/17/09

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