Acne Scarring

• Rolling scars: These depressed scars have sloped edges that merge with normal skin and can be circular or linear. Often, bands of scar tissue cause the skin to adhere to underlying structures. Rolling scars are the most common type of acne scarring.
• Icepick scars: These scars are sharp and deep, resembling small punctures. They are commonly found on the cheeks. Treatment can include specialized chemical peel procedures (TCA CROSS) to fill in the scars, small punch excisions, and a minor surgical procedure that removes the individual ice-pick scars. Laser resurfacing may follow to enhance results.
• Boxcar scars: Characterized by wide, shallow depressions with sharply defined edges, boxcar scars resemble cutouts. Shallow boxcar scars often respond well to resurfacing treatments, while deeper scars may require more aggressive approaches.
• Hypertrophic scars: Raised, firm scars that remain within the borders of the original acne lesion. These raised scars can often be flattened with intralesional steroid injections.
• Keloid scars: Raised, firm scars that differ from hypertrophic scars by being larger than the original acne bump. Sometimes, they grow significantly larger and become itchy or tender. These tend to occur on the chest and shoulders and are more common in patients with darker skin.

The treatment options for acne scars vary depending on the type and severity of the scar and may include:

• Acne scar surgery: This minor procedure helps make scars less noticeable by lifting the scar or breaking up the scar tissue. Subcision, a technique that involves breaking up scar tissue to induce collagen formation, is often combined with laser treatments for enhanced results. This method is suitable for depressed scars.
• Laser skin resurfacing: This treatment uses fractional laser light, which is clinically proven to break down scar tissue and promote new collagen formation, resulting in a more even, improved skin texture. Blending these scars in with the surrounding skin reduces their visibility. The number of treatments depends on the level of correction desired.
• Microneedling: This procedure uses physical needles to induce a controlled injury to the skin, resulting in collagen production that helps fill in depressed scars. Several treatments are usually required, but these can be completed with minimal downtime.
• Chemical peels: Chemical peels help improve acne scars by removing the damaged outer skin layers and filling deep depressions. There are several types of peels, ranging from mild to strong, and your type of scars and treatment goals will determine the best approach.
• Radiofrequency microneedling: An alternative to laser resurfacing, this is an enhanced version of microneedling and another technique used to stimulate collagen formation and tissue remodeling with minimal downtime.
• Dermal fillers: Fillers, such as hyaluronic acid, can be injected into depressed scars to elevate them and minimize their appearance. Some fillers are temporary, while others are permanent.
• Intralesional corticosteroid injection: Corticosteroid can be injected directly into raised hypertrophic or keloid scars to soften and flatten them over time; this can also help improve symptoms of itch or tenderness that may be present.