Acne Scarring: Treatment options
The internet will bombard you with thousands of miracle cures for acne scars, but if you are searching for a solution that won’t leave you looking like Michael Jackson, read the following options and then consult your dermatologist.
Laser treatment is the way of the future in most surgery procedures, because it leaves the least scarring and you won’t look like a burn victim afterwards. You should recover in three to five days.
Lasers recontour scar tissue and reduce the redness of skin around healed acne lesions. Carbon dioxide lasers are one of the most powerful treatments available because they produce the most heat. The heat energy penetrates deep into the skin to tighten the collagen fibres, which elevates the depressions to the level of the normal skin.
The Erbium: YAG laser is less potent, but works by emitting light through bursts of energy that are absorbed by water in the skin. This allows for precise sculpting of irregular scars.
Autologous fat transfer
If you don’t fancy the idea of your face feeling like a Star Wars set, you can opt for a treatment method that involves taking the fat from one part of your body and injecting it underneath your scars to plump them up to the normal skin’s level. It’s like liposuction and botox in one!
This method is only used for very deep and severe craters and you’ll have to have it repeated every six to 18 months, because your body reabsorbs the fat.
If you have deep ice-pick or pitting scarring a la Bryan Adams, it cannot be treated by lasers or fat transfer. “Punch” excisional surgery may help you.
During this procedure surgeons basically cut out the scar and stitch the resulting hole up so that it will heal properly and look like normal skin. Alternatively, a small skin graft (a patch of skin from another part of your body) will be placed over the wound. Both treatments are permanent.
Subcision is another surgical technique that involves the use of a blunt surgical probe that lifts up the skin and pulls it away from the depressed scar tissue underneath.
Dermabrasion is thought to be the most effective treatment for scars. It involves “sanding” down your surface skin and scar contours with a high-speed rotating wire brush. During healing, a new layer of skin will replace the abraded skin, making the face look a lot smoother.
Sounds like some kind of Chinese torture? Don’t worry, you will be put under local anaesthetic and the procedure only needs to be performed once. You will be out of action for one to two weeks, but the results will be permanent. Remember, no pain, no gain. It easily causes increased pigmentation in a sunny climate.
Instead of using the rather barbaric-sounding wire brush employed in the dermabrasion technique, this treatment makes use of aluminium oxide crystals that pass through a vacuum to remove the surface skin.
Only the skin cells at the surface are gently scraped away and new cell growth is stimulated, so this treatment has the added bonus of creating no additional wounds.
Although microdermabrasion does not sound very appetising, it’s often called the “lunchtime peel” because it is such a quick procedure and it leaves minimal redness.
This is not a very hectic procedure and it is best suited to people with very mild scarring. Because of the superficial nature of this method, multiple treatments will be necessary.
Keloids are the most tricky scars to treat. Surgical removal is hardly ever used on keloids, because if one’s skin is prone to forming keloids, more might actually form in response to skin surgery.
The only other two options are to inject steroids into the skin around the keloid, or to apply topical retinoic acid directly onto the scar.
Sometimes though, the best treatment for keloids is nothing at all.
What are the risks?
The different treatments available for acne scars all sound very high-tech and safe, and most of them are. But certain people, including patients that have recently taken Roaccutane, have active cystic acne or those that have unrealistic expectations of how the treatment will dramatically transform their lives, are not good candidates for treatment.
Resurfacing techniques may cause short or long-term pigment problems. Your skin tone may be increased temporarily or decreased for a longer period. It is safe to carry out procedures in Roaccutane patients but not until 6 - 9 months after they have finished treatment.
More scarring, infection and persistent redness can also result from treatments.
Any substances injected under the skin may be incorrectly positioned and may also cause allergies.
Some of these side effects are temporary, but others can be permanent, it’s just a risk that you will have to take.
Revision date: June 18, 2011
Last revised: by Dave R. Roger, M.D.