Acne is a common condition that affects most people at some point in their lives. For reasons that are not understood some people develop acne that leads to permanent scarring. The term "scarring" refers to a process where the collagen and elastic tissue within the skin are damaged from inflammation, leading pits and texture changes in the skin. Additionally, many patients develop color changes at the sites of prior acne blemishes, and although not technically scarring, it is often referred to as such. Types of Acne Scarring
There are different kinds of acne scarring: ice pick scarring, atrophic scarring, and hypertrophic scarring. Ice pick scars are deep, pitted scars that look like small holes in the skin. Atrophic scars are depressed areas of the skin that are not as deep. These types of scars can be further classified as distensible or non distensible. Distensible scars smooth out when the skin around them is gently stretched. Hypertrophic scars, which are more common on the back and chest, are thick lumpy scars. The most serious type of hypertrophic scar is commonly referred to as a keloid.
Color changes in acne are quite common. They usually resolve without treatment but can take years to completely disappear. There are three basic types: erythema (pink and purple patches at the site of acne lesions), hyperpigmentation (brown/black discoloration at the site of the acne lesion), and hypopigmentation (white marks at the site of a healed acne lesion). Because the color changes can be mistaken for active acne, treated of these conditions is often sought.
Treatment of Acne Scars
Acne scarring is permanent but can be treated. No treatment is 100% effective and the best result is improvement, not perfection. Optimum improvement often requires many different treatment approaches, depending on the kind and severity of scarring present. It is important that the acne is controlled before treatments are begun. Otherwise, new scars may form.
Dermabrasion
This is a relatively invasive procedure in which the skin is mechanically sanded to improve the look of scarring. Although it can be effective, Doctors Calkin and Boudreaux do not perform this procedure.
Laser Resurfacing
Laser resurfacing has been used for the treatment of acne scarring since early 1990’s Resurfacing lasers use a high-energy beam of light that target water in the skin and subsequently vaporize the skin removing the epidermis and the superficial dermis. Like dermabrasion, laser resurfacing is ablative meaning that it destroys the outer layers of the skin. Ablative techniques are effective but less popular because they require significant recovery time and have significant risks. We have achieved similar results to laser resurfcaing using our Fraxel laser. Please see the Fraxel section for more information.
Subcision
Subcision is used for atrophic scarring. Local anesthesia is administerd, and a specialized needle is then inserted under the scar and manipulated in order to release the scar tissue. This method has been tested in recent studies and shown to be effective. It is most often used in conjunction with other procedures such as Fraxel and dermal fillers.
Punch excision with or withoutgrafting
For deep ice pick scars, the most effective treatment is complete removal of the scar. A small, round, cookie-cutter-like device (called a punch) is used to cut out the scar and the edges of the wound are then sewn together with a suture. In this case, a deep,, pitted scar is traded for a tiny line scar that can later be treated to further blend into the rest of the skin. Larger scars can be removed and then filled with a skin graft, taken from normal skin (usually behind the ear). Grafts are later contoured with dermabrasion or lasers to blend them into the rest of the skin.
Dermal Fillers
Substances that add volume to the skin can be used alone or in combination with the above procedures. Fillers can improve the appearance of acne scars by flattening and lifting the scar but their effect is temporary. To maintain the result, the lesions must be re-injected at regular intervals. Please see our section on Filler Products for more information. All of the fillers listed there can be successfully used to treat acne scarring. Our doctors will help you decide if one is right for you.
Chemical Peels
Chemical peels are another way to resurface the skin. Chemical peels produce controlled injury to the skin that promotes the growth of new skin with an improved appearance. Many different chemicals can be used including glycolic acid, trichloroacetic acid (TCA), salicylic acid, and “Jessners” solution, and phenol. The different chemical solutions produce different degrees of injury to the skin. Medium depth and deep peels produce injury within the dermis and can improve the appearance of atrophic acne scars. The deeper peels may be more effective but carry more risks such as infection, scarring, and discoloration, especially for patients with dark skin. For this reason our doctors choose to use medium depth chemical peels only. If further treatment is necessary, one of the other techniques is usually employed.
Treatment of Hypertrophic Acne Scars
Although less common, hypertrophic (and keloid) scars can be more disfiguring and harder to treat than other kinds of acne scarring. This type of scarring is more common on the chest and back. Treatment usually involves Vbeam laser, topical steroids, injected steroids, bleomycin injections and occasionally Fraxel laser.
Treatment of Discoloration From Acne
Color changes from acne scarring, as discussed above, are usually not permanent. The one exception to this are the white, hypopigmented patches that can develop after acne, especially if lesions are picked. The white color is hard to treat but can sometimes be blended using the Fraxel laser. The other types of discoloration can be allowed to fade on their own or they can be treated as outlined below.
Topical Treatments
Prescription creams containing single medications or combinations of medications such as tretinoin, hydroquinone and topical steroids can be quite effective when used properly. Patients need to be diligent about using the products as directed and patients must use a recommended sunscreen in order to achieve results. For those patients wanting natural ingredients there are some botanically based lighteners than can be helpful. Pleas see our cosmeceutical section for more information.
Chemical Peels
Chemical Peels can be used with great success to lessen discoloration from acne. They can also greatly improve active acne. In this case, superficial chemical peels are utilized which greatly minimizes risks as well as recovery time. A series of peels is necessary to achieve optimum results.
Microdermabrasion
Often referred to as a "lunch time" procedure, microdermabrasion is a popular treatment which is classified as a very superficial dermabrasion. We use a crystal free, diamond tipped wand to gently resurace only the most superficial layers of the skin. Microdermabrasion can be used to treat acne and the hyperpigmentation caused by acne. It is painless, and there is no recovery time after the procedure. However, multiple treatments are necessary. Results can be improved when combined with topical treatments, chemical peels and other procedures. Contrary to what you might have heard or read, microdermabrasion is not a treatment for acne scarring.