Acne Scarring
Quick facts
- There are various types of acne scars, each treated with different methods
- Skin needling, plasma skin regeneration, laser treatments, subcision, chemical peels, microdermabrasion, dermal fillers, and TCA cross are all methods of treating acne scars.
- Generally speaking, the more invasive the treatment, the longer the recovery period and the better the results
What types of acne scars are there?
- Macular scarring - this type of acne scarring is characterised by flat areas of increased and decreased pigmentation as a result of acne. Although there are not any indentations in the skin or raised scars, this is considered as a scar by many patients who have this problem.
- Boxcar scars - these acne scars are superficial punched out scars that have sharp vertical edges on cross section, and can be round or oval shaped when seen from above.
- Rolling scars - these acne scars appear as undulations in the skin and are usually caused by tethering of the skin to underlying structures
- Deep divots - these are simply very deep scars that involve loss of subcutaneous tissue volume and result in a large divot.
- Ice-pick scars - deep but small holes in the skin, similar to the indentation left by an ice-pick.
- Hypertrophic scarring - where there is a raised and often pigmented scar as a result of acne.
- Keloid scars - where the size of the scar is significantly raised, red/purple, and disproportionate to the size of the initial trauma caused by the acne
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What categories of severity of acne scars are there?
Acne scarring can be categorised as (Goodman & Barron);
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Grade 1 - macular scarring or flat scarring that is characterised by flat areas of increased or decreased pigmentation visible from greater than 50cm.
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Grade 2 - mild disease that is visible at distances of less than 50cm and can be covered by make-up. Examples include mild rolling acne scars.
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Grade 3 - moderate disease that is visible at 50cm or greater and is not easily covered with make-up or the normal shadow of a shaved beard hair. Stretching the skin can flatten the scar. Examples include more significant rolling scars, shallow boxcar scars, and mild to moderate hypertrophic scars.
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Grade 4 - severe disease as in grade 3 but scarring is not flattened by stretching the skin. Examples include severe boxcar scars, deep divots, ice pick scars, and hypertrophic/keloid scarring (very raised/pigmented scars).
How can I treat macular, grade 1 scarring?
How can I treat more superficial, grade 2/3 scarring?
More recently, the Rhytec Portrait Plasma Skin Regeneration (PSR) machine has been a more viable alternative to resurfacing acne scars without the side effects and prolonged downtime of carbon dioxide lasers. The total downtime is approximately 10 to 14 days for a high-energy treatment, and so far there have been no cases of scarring or loss of pigmentation internationally.
Skin needling is another effective method of treating superficial acne scars by puncturing the skin with multiple fine 3mm needles attached to a small rolling pin. This stimulates collagen production and helps to lift up any 'indented' scars. The advantage of this treatment over plasma skin regeneration is the fact that it can be used on all skin types including darker skin types. People of Asian, Indian, African, and European background are able to have this treatment with less risk pigmentation changes post-treatment. Also, it penetrates very deeply so that collagen can be stimulated on deeper acne scars. Skin needling generally requires several treatments, usually once a month. Usually it takes 3 to 7 days to recover from the treatment, depending on the degree of the treatment. Fraxel laser is another method similar to skin needling that uses a laser to create multiple pin-point injuries to the skin. However, the penetration depth is approximately only half of that of skin needling (1.4mm), and it is our opinion at The Victorian Cosmetic Institute, that skin needling is more effective in most cases.
Subcision is another technique that is suitable for treating depressed acne scars. It involves putting a special needle under the depressed scar to help release it from the underlying structures. It is often combined with skin needling.
Our Medlite q-switched Nd:YAG laser, which is used also for tattoo removal and pigmentation removal, can also be used at settings to help promote collagen production and help improve mild superficial acne scarring to help raise small indentations in the skin. The advantage of this treatment is that it has only a small amount of downtime in comparison to the above treatments. Usually, several treatments are required. There have been clinical studies showing the effect of this laser on flattening the topography≠of acne scarred skin, and a general overall improvement in skin texture and smoothness.
Chemical peels are another method of treating more superficial acne scarring. Generally, medium to deep chemical peels are required to achieve a significant result, but a series of more superficial chemical peels could help achieve some improvement in milder acne scarring without significant downtime.
How can I treat severe/grade 4 acne scarring?
In most cases of severe scarring it is only possible to improve the scarring, but not to completely irradicate it.
Techniques such as skin needling, subcision, skin resurfacing, as mentioned above are effective in the treatment of severe acne scarring.
For ice-pick scars, there is a technique called TCA Cross. This involves careful placement of high concentrations of trichloroacetic acid into the ice-pick scar. This stimulates the production of new collagen and remodelling of existing collagen to fill in the acne scar. The advantage of this treatment is that it is localised to the problem only and not the unaffected skin.
Deeper scarring may also require filling with fat grafts or dermal fillers. Fat grafting will need to be performed by a plastic surgeon and tends to be more permanent.
Significant keloid or raised pigmented scars may need to be treated with intralesional corticosteroid or cytotoxic injections (5-FU) to help reduce the bulk of the scar.
Overall, there are a number of treatments that are effective in the treatment of acne scarring. As a rule, the more invasive the procedures will yield better results with fewer treatments, but will require more recovery or downtime.
A consultation with one of our medical staff will help assist you in your decision about which treatment will best suit your goals and lifestyle. Due to the large number of treatments available, a consultation will help you decide which best treatment suits you. As a rule of thumb, the more invasive the treatment, the greater the downtime, and the greater the improvement.
The first step is simply contacting us for your initial skin consultation, where we will discuss with you what is a realistic and achievable outcome, and what to expect from your treatment
Making that first phone call about any cosmetic procedure can be a confronting task - many of our patients have preferred filling out our online enquiry form. We can then contact you with an understanding of the results you are hopeful of achieving and ensure the treatment is appropriate.
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