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Acne Scar Treatment

Acne therapy involves physical treatment to obtain therapeutic results, which is the leading concern for many acne patients. Acne scar treatment plays an important part in this.

Types of Scars

Acne scars are defined by their shape, number, depth, localization, and duration, as well as the patient’s skin type.

Macules, or “pseudoscars,” are the most inflamed lesions receding into flat reddish spots in their final stages. People with darker skin tend to suffer more of these scars.

Keloids are hypertrophied scar tissues that results from increased tissue formation and excessive collagen during healing.

Other acne scar types are caused by loss of tissue, such as the following:

Ice pick scars are named as such because of their appearance. The lesions have jagged edges and it may be superficial or deep.

Box-car scars are depressed fibrotic scars with sharp edges and steep sides. They are very similar to chicken pox (varicella) scars. Broader than ice-pick scars, they are round, polygonal, or linear at the skin surface.

Rolling scars are deep and soft and have gently rolling edges that merge with the skin.

Atrophic scars are small and soft. These white scars are slightly raised above the surrounding skin.


All patients need to know the risks and benefits involved in every procedure. There is also a need to explain that results vary and that complete erasure of the scar may not be possible, and multiple treatments may be required for best results. The patient’s medical background must also be examined for any history of oral therapy, keloids, or persistent facial acne—acne scar treatment is usually discouraged in the presence of any of these.

Types of treatments

Collagen injections: Collagen, a natural substance in the body, is injected under the skin to fill deep soft scars. The cosmetic and aesthetic effect lasts for three to six months and may be extended with further injections. It is not effective for ice pick scars and keloids.

Autologous fat transfer: A sample of fat is taken from another site of the patient’s body. The fat is injected into the dermis (surface) of the skin with the purpose of pushing and elevating the depressed scar. Frequent sessions are expected as the skin absorbs fat in 6–18 months.

Dermabrasion: The affected area is injected with local anesthetic, and a high-speed brush or a fraise removes the surface skin and changes the contours of the scars. Superficial scars can be completely removed and the depth of deep scars can be reduced. The procedure is best for light skinned patients, as darker-skinned patients may suffer coloration and require further treatment.

Microdermabrasion removed surface cells by using aluminium oxide crystals passing through a vacuum. Microdermabrasion is only suitable to treat fainter acne scars.

Chemical peels

Chemical peels may either be superficial, intermediate, or deep.

Superficial peeling removes macular scars and any accompanying pigmentation, reducing skin pore size and giving the skin a healthier complexion. Ice pick and U-shaped scars may be given this treatment. For 15 to 30 days prior to this treatment, the skin must be prepared with keratolytic products and depigmenting creams. This type of chemical peel has the highest risk-benefit ratio, owing to side effects such as erythema folliculitis, flare of acne lesions, and hypo- or hyper-pigmentation.

Intermediate and deep peeling on the other hands have lower risk-benefit ratios than superficial peeling. The effect on atrophic scars are mild and short-lived, and keloids are not affected.

Laser Resurfacing

Varieties of laser treatment are possible depending on the intensity and wavelength of the lasers. Using a wand-like laser handle, scars literally disappear and are replaced by fresh skin cells. One of the laser's most significant advantages over traditional techniques for skin resurfacing is that treatment is relatively bloodless and non-invasive. The procedure also offers more control in the depth of penetration of the skin's surface, allowing an increased degree of precision and safety in treating delicate areas.

While laser surfacing is known to be a good acne scar treatment, erythema is an almost certain side effect, lasting for more than three months in more than half of all patients. Hyperpigmentation, although lasting less than three months, also occurred in 29% of all patients. Lesion flare-ups and other problems requiring medical intervention were common.

Depressed and hypertrophic facial scars can be raised by pulse-dye and intense pulse light laser, and atrophic and shallow U-shaped scars can be treated by high-energy pulsed CO2 lasers.

Skin Surgery

Punch excision can treat ice picks and deep scars. This procedure utilizes a tool that is usually round and sharp resembling a cookie-cutter that comes with a diameter ranging from 1.5 mm to 3.5 mm. The size of the tool is matched to the relative sized of the area of the scar. Under a local anesthetic, the area is punched and the scar is excised with the skin edges being sutured.

Punch elevation combines punch excision and grafting without causing irregularities in skin color or texture. This treatment can only treat scars with sharp edges and normal bases, making treatment of box car scars by this method impossible..

Skin grafting, otherwise known as skin replacement, is especially needed to close the defect of unroofed sinus tracts. This is especially effective for deep scars especially on the face.

Combination Treatments

Latest research shows that combination treatments have tremendous effect on the recovery of the skin’s elasticity and removal of scars. An example would be that of combination of dermabrasion and punch excision of scar tissue make many ice-pick scars treatable and less evidence of the scar is seen.