Around 80% of adolescents and 5% of adults experience acne at some point.  For some, their acne is so bad that it leaves permanent acne scars that can be disfiguring.  There are several treatments to achieve acne scar reduction.  If the scarring is mild, topical skin products may help, but more severe scarring is usually treated by performing surgical procedures and/or skin resurfacing treatments.

Types of Acne Scars

Acne scars are separated into different types to help determine the best type of treatment.  Here are the most common types:

Icepick: Also known as pitted scars, these are narrow and sharp, as if skin has been pitted by an icepick.  These scars are usually narrower than two millimeters and go down too deep into the skin to correct with skin resurfacing treatments.

Rolling: These scars have a rolling or undulating wave-like appearance. This is the result of skin that otherwise appears normal being tethered to the tissue deeper below in the skin.  Skin resurfacing will not effectively treat rolling scars.  They should be treated by breaking up the fibrous bands deep in the subcutaneous tissue that is the deepest layer of the skin.

Boxcar: These are round or oval in shape and have sharp vertical sides.  They are similar to chickenpox scars.  The shallow ones that are up to half a millimeter in depth can often be treated with skin resurfacing treatments.  If the scar is deeper than half a millimeter, other treatments will work better.

Acne Scar Reduction Techniques

Before deciding what kind of treatment to use, it is necessary to consider the type of scar and whether or not you have used accutane before.  Then, you should discuss the benefits and risks of each type of treatment with your doctor before proceeding.  There are many different types of treatments, but here are the most common types:

Fillers

Fillers are injected into the skin to raise the skin and plump up the acne scar to make it appear smoother. Shallow, round scars can be effectively treated with fillers.  There are many different kinds of fillers, including bovine collagen, human collagen, fat, polytheyl-methacrylate microspheres with collagen , and polhyaluronic acid derivatives.  Fillers do not stay in the skin permanently, so you must have repeated injections to keep up the treatment.

Punch Excision

Punch excision is used to treat deep acne scars, such as the icepick and deeper boxcar scars.  A punch biopsy tool is used to excise the scar and the edges of the skin are sutured together.  This closes the skin so that a new, smaller scar is formed.  This new scar usually fades so it is no longer visible.  If it remains visible, you can treat it with skin resurfacing.

Alternatively, the punch excision can be combined with a skin graft.  Rather than suturing the edges of the skin together, it is filled with a punch skin graft that is commonly removed from behind the ear.  If any color or texture difference is still noticeable after this procedure, skin resurfacing can correct it.

Punch Elevation

Punch elevation is used to treat some deep boxcar scars.  A punch biopsy tool is used to excise the bottom of the scar which is then elevated to the skin’s surface and reattached with sutures or skin glue.  The risk of color or texture differences is less with this procedure than with the skin graft replacement described above. There is also less risk of having a visible scar than with the normal punch excision where the edges of the wound are sutured together.

Subcision

This procedure involves a subcutaneous incision made with a special needle that is beveled so it is parrallel to the skin’s surface.  After local anesthesia is given, the needle is moved under the skin to  break up the bands of scar tissue that tether the skin to the subcutaneous tissue and cause rolling scars.  It can also help new collagen form.

Subcision causes bruises, but they fade in about a week.  There is also a risk of bleeding and forming subcutaneous nodules.  Both of these problems can be handled by properly controlling bleeding with anesthetics and bandaging and injecting corticosteroids into the nodules.

Skin Resurfacing Techniques

There are a few different methods of acne scar reduction that use skin resurfacing techniques.  Dermabrasion is one of the older procedures that is not really used anymore since there are newer and easier treatments available.  Microdermabrasion is different from traditional dermabrasion and is sometimes used to treat more severe cases of icepick scars.

Laser treatments are the most popular type of skin resurfacing.  There are two types of lasers, and it is the ablative type that is used for skin resurfacing.  Ablative lasers remove the top layers of the skin and burn the scar tissue away.  The skin then heals and appears newer because collagen is stimulated and this tightens the skin and reduces the visibility of scarring.

The most commonly used lasers for acne scar reduction are the ultra-pulsed carbon dioxide and erbium YAG lasers.  It is very important to take proper care of your skin after having laser treatments because the skin will be very sensitive as it heals.