New Techniques for Acne Scar Revisions

Acne is a common skin condition that about 80% of people develop in their teenage years. Often, acne may resolve itself without leaving behind permanent marks on the skin; however certain individuals may get displeasing acne scars. If any skin defects remain even after 1 year, it is considered to be a permanent defect or scar.

Types of Acne Scars

Acne scars can be classified into two major types based on the response of the tissues to the inflammation as follows:

• Scars formed by increased tissue formation–Hypertrophic or Keloid scars
• Scars formed by loss of tissue
  
  • Ice-pick scars
  • Boxcar scars
  • Rolling scars
  • Depressed fibrotic scars
  • Superficial and deep soft scars
  • Atrophic macules

Treatment Options

There are several new techniques available for acne scar revision and your dermatologist will discuss the most suitable option for your particular situation.

• Chemical peel: This technique involves applying a high-potency acid to remove the top layer of the skin. New skin forms within 15days. It is helpful to treat small scars. It is necessary to protect your skin from the sun exposure after a chemical peel is done to prevent further irritation.
• Dermabrasion: This procedure is performed at your doctor’s office under local or general anesthesia. Your doctor will abrade the top layer of your skin with a handheld device which moves in a back and forth or in a circular motion over the skin. Cold compresses are used to control bleeding and the area will be covered with a sterile dressing.
• Laser resurfacing of scars: This is a newer technology used to treat depressed acne scars. The tissue penetration power of a YAG laser helps to improve the scars and the infrared beam of the carbon dioxide laser may be used to elevate depressed scars by tightening the collagen fibers. After the treatment, antibiotics will be prescribed to help healing and a surgical dressing is applied. You can resume normal activities within 2 weeks.
• Soft-tissue augmentation: This technique is used to treat scars caused by loss of tissue. Your doctor may inject fat fillers such as collagen, hyaluronic acid, or polymethylmethacrylate (PMMA) into subcutaneous fat below the scars to elevate the scar to skin surface level and give your skin an even surface. Repeated treatments may be recommended.
• Intralesional steroid injection: Steroids are directly injected into the scars. This helps to improve keloid scars.
• Excisional surgery: Acne scar surgery is considered the most effective treatment method to treat depressed acne scars. It aims to convert a bigger, deep scar to a smaller, flat scar which can be treated with laser resurfacing. All these techniques are performed under anesthesia.
  
  
  • Punch excision – Punch excision is a technique used to correct icepick and deep boxcar scars. In this method a round, sharp and small sized (matched to the size of the scar) punch biopsy tool is used to remove the entire defect. The edges will be sutured.
  • Punch elevation – Punch elevation is a technique used for wide boxcar scars. A punch tool similar to a punch excision tool is used to excise the base of the scar but the walls of the scar remain intact. After the scar is removed, the remaining basal tissue is then raised to the surface of the skin and attached with sutures or steri-strips.
  • Subcutaneous incision – This technique is used to treat rolling and depressed scars. A special needle is inserted under the skin to separate the skin from the scarred surface. The scarred surface will then be flattened.
  • Shave Excision – Shave excision is a technique to treat elevated and hypertrophic scars or keloids. The scar is removed with a flexible blade or scalpel to bring it in level with the surrounding skin.
  • Fusiform (Elliptical) Excision – This commonly used technique is preferred for elevated and hypertrophic scars as well as depressed wide scars.

It is important to remember when undergoing any treatment for acne scars that improvement is the goal. Several treatments may be necessary to achieve optimal correction. Combining these different procedures may be needed to better address individual problems. Additional sessions to treat other areas or to retreat previously addressed areas can be scheduled at monthly intervals.

Schedule your consultation with Dr. Resnik

For more information from the American Academy of Dermatology.