Acne scars can take several different forms. Individuals who are prone to raised scars have over-prodcution of collagen in the healing phase, resulting in raised, hard nodules. Indented or pitted scars are the most common result of severe acne. These scars may look like a large deep pore and are often called “ice pick scars”. Or, they may be broad and deep like a saucer.
Raised acne scars can be treated with injection of cortsone directly into the scar. A series of 3-5 treatments is usually successful in flattening the scar. If the site of the scar is redder than the surrounding skin, treatment with a pulsed dye laser ( aka VBeam laser) will help to resolve the redness and help to flatten the scar.
Indented scars usually require laser treatment to stimulate new collagen in the deep layers of the skin. This can be accomplished with a series (4-5) of fractional non-ablative laser treatments.(aka Fraxel laser) This laser uses a handpiece with a computerized scanner to target collagen in the deep layer of the skin with little or no peeling of the surface skin. Each session treats about 20% of the skin cells, which allows for healing in 2-3 days and gradual improvement over the course of treatment. Or, alternatively, 1 or 2 fractional ablative laser treatments can be done. (aka fractional CO2 laser-multple brand names) This type of laser targets the collagen deep in the skin but also peels the top skin layer. There is a week of healing time as well as an additional week of pinker, more sensitive skin. Most patients are very happy with the results. I see 50-75% improvement in scarring depending on the severity pre-treatment.
Additionally, wider deeper “saucer-like” acne scars may improve with acne scar revision or repair. This technique involves use of several different instruments to cut out or elevate indented scars, combined with suturing. It works best when combined with one of the laser treatments described above.
Wrinkle fillers such as Restylane (hyaluronic acid) may temporarily or sometimes permanently improve deep indented acne scars. Since all fillers stimulate the body’s own collagen, permanent improvement is the result of the patient’s collagen repair.
Patients with darker pigmented skin often develop brown spots at the site of healed acne. This type of discoloration is easily treated with prescription skin lighteners containing 4-6% hydroquinone combined with tretinoin ( aka Retin A). If 3-4 months of home treatment does not resolve the pigmentation, superficial peels done by an esthetician usually will work.
I would be happy to discuss your acne scar concerns and see which approach is right for you.