Acne Scarring Treatment

Types of acne scars

Acne tends to cause various types of scars during the healing process beyond the simple classification of raised or indented. It is beneficial to be aware of each type for more effective treatment for acne scars.

• Macular scarring: This type 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 a scar by many patients who have this concern.
• Boxcar scars: These are superficial punched out scars that have sharp vertical edges on the cross section, and can be round or oval shaped when seen from above.
• Rolling scars: These 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 (also called depressed scars): Deep but small holes in the skin, similar to the indentation left by an ice-pick.
• Hypertrophic scarring and keloid scars: Where there is a raised and often pigmented scar as a result of acne. They may be red/purple, and disproportionate to the size of the initial trauma caused by the acne.

How to treat acne scars

With various types of acne scars capable of forming in the skin, treatment for acne scars is just as varied.

There are three main ways to treat acne scarring, which are through laser, non-laser, and skincare treatments. The full extent of the methods involved with each treatment avenue will be explored below.

Laser treatments for acne scars

With the most advanced technology available, both non-fractional and fractional lasers can treat acne scarring. This will depend on the types of scars and can provide dramatic results.

Carbon Dioxide Laser (fractional)

Laser resurfacing with a carbon dioxide laser is one method of treating severe acne scarring. This laser removes the top layer of skin, resulting in the growth of smoother new skin that lessens the appearance of scarring. Laser resurfacing not only addresses the scarring, but can also significantly improve the appearance of sun damaged, pigmented, or wrinkled skin. 

Although this treatment is very effective, there is usually a minimum two week recovery period associated with the procedure, and it often requires sedation. It’s a more intensive procedure which is only generally suited to those with lighter skin tones. 

Fraxel Laser 

The Fraxel laser is classified as a non-ablative laser since it does not destroy any tissue, but instead heats columns of tissue with laser energy. It is this heat energy, set to a 1550 nm wavelength, that stimulates new collagen production in the skin.

Carbon Dioxide Laser (non-fractional)

At the Victorian Cosmetic Institute we use the Lumenis Ultrapulse fractional carbon dioxide laser with the Deep Fx handpiece for acne scars. This handpiece fires very fine columns of laser energy deep into the skin with only a small percentage of the skin’s surface being affected. This method can be used alone or in conjunction with cortisone for optimal results.

Non-laser treatments for acne scarring

Several treatments for acne scarring don’t use laser or thermal energy, providing a broader range of treatment options.

Skin needling is commonly used to stimulate collagen production, to improve the appearance of acne scars, and can be performed with or without RF energy. Other medical treatments include chemical peels, subcision and tixel, all of which and more will be covered in this section.

Skin needling

Skin needling, also known as microneedling or pen needling, is a very effective method of treating superficial acne scars. It is performed with a pen needling device with fine needles to puncture the skin to stimulate collagen production, which then helps to lift up any ‘indented’ or atrophic scars. 

The advantage of this is that it can be used on all skin types, including olive and dark skin. People of Asian, African, and European background are able to have this treatment with less risk pigmentation changes in comparison to laser treatments post-needling. The needles penetrate the skin anywhere between 0.2mm ot 2.5mm depending on the severity and location of the scarring.

Infini RF needling

Infini RF needling combines both microneedling with radiofrequency. It is effective for treating various types of acne scars while also tightening the skin. It is particularly suited to olive or darker skin types. 

This non-laser method has a lower risk of post-inflammatory hyperpigmentation than laser treatments, and the recovery time is significantly less than carbon dioxide Co2 laser resurfacing. Hence why it is a common method for treating both old and new acne scars.

Subcision 

Subcision is a method of undermining acne scars using a special needle or cannula, typically targeting depressed scars. The size of the scar usually needs to be fairly large or deep for the accurate insertion of the needle or cannula. The tool breaks the skin free from the scar tissue that holds it down which is effective due to the fact that acne scars are depressed because the skin is tethered to the underlying tissue. Usually reserved for the deeper scars, it is a simple mechanical technique, but very effective. 

TCA Cross 

TCA CROSS is an effective method of improving most types of scarring, especially acne. It is most commonly used for small indented acne scars. 

The procedure involves careful placement trichloroacetic acid into the scar with a toothpick. This stimulates the production of new collagen and remodelling of existing collagen to fill in the acne scar. 

The advantage of TCA Cross is that it’s only localised to the issue and not the unaffected skin.

Chemical peels 

Chemical peels are a method exclusive to treating more superficial scarring due to its focus on the top layers of the dermis. Generally, medium to deep peels are required to achieve a significant result as peels are used for superficial resurfacing. However, a series of more superficial peels could help achieve some improvement in milder acne scarring without significant downtime.

Optimal results for severe acne scars are best achieved using alternative treatment methods, especially when located deeper in the dermis layers.

Dermafrac needling

Dermafrac needling utilises microneedling on multiple layers of the dermis to generate micro channels to the dermal junction, while also infusing the tissue layers with topical serums. This combination of techniques can work on most skin types and concerns, including acne scarring.

Here at Victorian Cosmetic Institute, we offer four serums to choose from for Dermafrac treatments. However, it is our Clarify serum that is most suitable for treating acne scars. Salicylic and Lactic acid are injected to help open clogged pores, clear debris, exfoliate the skin, and restore collagen in the face. It is ideal for those dealing with current acne or old and new acne scars.

Tixel treatment

The Tixel treatment for acne scars involves stamping a heated metallic plate with pyramid-shaped spikes onto the areas of the skin with acne scarring. This usage of thermal energy is similar to the fractional carbon dioxide laser treatment, but Tixel requires less recovery time.

The procedure overall remodels and improves the skin by the 81 pyramid-shaped spikes of the tool’s tip delivering a short burst of heat energy. Only the outer layers of the skin are targeted, increasing collagen production while also tightening the skin. This helps improve the appearance of various skin scars, even on more sensitive skin.

Skincare for acne scarring

Several skincare products can be used at home to help reduce acne scars, including specific skincare for acne. These products can be easily added to your skincare routine to lighten the scars and benefit the general health of your skin. It’s also crucial to prevent future acne breakouts to reduce the chance of developing new scars.

To begin with, daily skincare routines should build a foundation with the use of cleansers every morning and night. This product removes congestion in the skin and removes dead skin cells, helping to prevent further acne from forming and eventually possibly scarring. Also consider the occasional use of exfoliators to help with cell turnover and prevent the formation of scar tissue.

Sunscreen should also be incorporated every day, and regularly reapplied, to help protect the skin from sun damage. Any skin type, including darker skin tones, can be easily damaged by the sun’s UV rays, resulting in hyperpigmentation, wrinkles, and the worsening of acne scars. The application of sunscreen can help prevent this.

Hyperpigmentation is another common side effect of acne, and is usually a result of inflammation or trauma to the skin. Medical-grade skin care can assist in treating this problem. Acne scar serums, pigmentation skincare, or vitamin A serums can help skin turnover and keratinisation (which can block pores), reducing acne.

If you are unsure about what kinds of skincare products will be beneficial for acne scar treatment, you can also look at their ingredients. Specific ingredients are known to be more effective in treating scars, such as salicylic acid products, or retinol serums. Other ingredients to keep an eye out for include:

• Glycolic acid
• Vitamin C
• Vitamin B
• Vitamin E

It is important to treat the general quality of the skin in addition to treating acne scarring. This helps to reduce the overall appearance of the scars and maintain the skin’s health in the long term.

Risks and benefits of acne scarring treatment

Before undergoing any medical procedure, it’s essential to be aware that there are potential side effects and risks alongside the benefits. Understanding these factors is crucial. The risks and benefits associated with acne scarring treatment depend on the specific treatment you’re recommended. During your consultation, make sure to ask your medical practitioner to explain anything you’re unsure about. You can find more information about these risks and benefits on the following pages of our most commonly performed treatments for acne scarring.

• Infini RF needling
• Skin needling
• Fraxel laser
• Chemical Peels

FAQs 

How do you make acne scars go away?

Scarring can be treated through a variety of different methods, with varying recovery times. Skin needling and laser resurfacing are some of the most common methods. You should always consult a medical practitioner to decide which treatment is right for your skin type and level of scarring.

Can acne scars be removed permanently?

The permanence of your acne scars may depend on the severity, but it is certainly possible to make scarring less noticeable through time and proper treatment.

How do I know which acne scar treatment is right for me?

You will require a consultation with one of our practitioners, who will ask you about your skin concerns and the goals you hope to achieve. They will assess the severity of your scarring and recommend a treatment plan based on your skin type and the time you have available for recovery.

How long does it take for acne scar treatment to work?

The length of time required to see results will depend on the treatment you’ve chosen, and it is usually best to stick with one treatment until the results are clear. For both laser treatment and skin needling, you should start to see some results after 4-6 weeks, but you may not see the final results until after about 3 months.

How many treatments do you need for acne scars?

Although there have been many advances in how to treat scars, it remains a difficult skin concern to correct. It also depends on which treatment you undergo for your acne scarring. However, due to the nature of the problem, it is not possible to completely remove scars in most cases. Most of the treatments for acne scarring require multiple sessions to achieve the best result.

As a general rule, we allow anywhere between 1 to 2 months as a minimum period between treatments. This time interval in-between is to allow for recovery and for the collagen formation to commence. New collagen formation can occur for up to 1 year post treatment, however multiple treatments are recommended during that time to continue stimulating further collagen and elastin production.

What should I expect after my acne scar treatment?

After most treatment methods, your skin will be red and slightly inflamed for one to two days. Some treatments, such as the non-fractionated carbon dioxide laser  are more invasive than others and will require at least 2 weeks of recovery time.

How much does acne scar removal cost?

The cost of acne scar removal depends on the type of treatment used and how many sessions are required for optimal results. During your initial consultation, you will be informed about the recommended course of action for treatment, including the prices for our services.