Acne Scar Treatment

A needle is used to inject filler material into the atrophic scar. There is a wide range of materials used, from bovine collagen to fat to silicone; most are not permanent. Researchers are still searching for the ideal material.

When fat is used, it is taken from elsewhere on the body (thighs, abs, buttocks). 50% of fat will be resorbed after 1 year.

Silicone and Gore-Tex® are permanent. However, silicone has significant potential side effects, and Gore-Tex is not FDA approved.

A solution containing alpha hydroxy acid (AHA) or beta hydroxy acid (BHA) is applied with gauze or cotton balls, then neutralized or washed off. The solution exfoliates the skin, removing the surface layer.

Light chemical peels aim to soften the appearance of minor surface imperfections, and are not adequate for most forms of acne scarring.

1-2 coats of 10%-40% TCA (tricolor acetic acid) is applied to skin and left on 30 seconds to 10 minutes, removing the top layers of skin. 60%-100% TCA is sometimes applied directly to scars.

Jessner's solution (glycol acid, salicylic acid) is another type of medium peel.

Medium depth chemical peels are for slight imperfections and are unlikely to noticeably improve acne scarring.

Because of the strength of the acids used, medium peels must be performed by a qualified professional such as a dermatologist or esthetician.

A plastic surgeon or dermatologist applies an extremely acidic solution (phenol or TCA) to the skin, thus removing surface as well as deeper layers of skin, allowing the skin to grow anew. Deep peels are serious medical procedures, requiring full cardiopulmonary monitoring and intravenous hydration; phenol in particular can be toxic to the kidneys.

Some doctors use general anesthesia or heavy sedation due to the severe pain these peels can inflict.

Very cold liquid nitrogen is applied to the scar with a cotton ball or sprayer. Time of application can range from 10 seconds to 2 minutes. Sometimes this is combined with steroid injections for better results.

The goal of cryosurgery is to freeze the scar, which damages the scar/skin tissue. The tissue dies and is sloughed off, flattening the formerly raised area.

Fluorouracil (a cancer drug) or bleomycin (an antibiotic) are injected into the raised or keloid scar, in the hopes of improving the scar's appearance.

These medications are often injected in conjunction with low-strength steroids to improve results.

High-speed (30,000 to 60,000 rpm) diamond or wire wheel brush or sandpaper removes skin surface, providing removal of superficial scars and reduction of deeper scars.

Operator dependent!: be certain to find an experienced, qualified professional.

Often used 6-8 weeks after surgical scar removal procedures to smooth out the surface texture.

Laser resurfacing involves the use of a laser to remove skin so new skin can form in its place. This is a relatively new procedure and results can vary. Theoretically, laser resurfacing is promising because the penetration depth into the skin is more easily controlled with a laser than with other methods. The procedure involves passing the laser over the treatment area 1-3 times and can take just a few minutes for small areas or an hour or more for large areas. Local anesthesia is used.

The CO2 (carbon dioxide) laser is slightly more powerful than the Er:YAG and thus tends to produce somewhat better results, but also comes with more severe side effects, and a longer recovery time.

Laser resurfacing involves the use of a laser to remove skin so new skin can form in its place. This is a relatively new procedure and results can vary. Theoretically, laser resurfacing is promising because the penetration depth into the skin is more easily controlled with a laser than with other methods. The procedure involves passing the laser over the treatment area 1-3 times and can take just a few minutes for small areas or an hour or more for large areas. Local anesthesia is used.

The Er:YAG laser or Erbium (YAG) as it is sometimes called was designed to have more mild side effects than the CO2 laser. Not a lot of research has been done to comparing the Er:YAG to the CO2 or the fractional laser.

Sometimes called “the laser equivalent to skin needling”, this laser creates light on only a "fraction" on the skin in spots.

Milder than traditional CO2 ablative laser; results are less impressive but side effects are also less severe.

Microdermabrasion is often confused with Dermabrasion, but is very different. Microdermabrasion is a superficial treatment, often at a spa or esthetician's office, which produces no results for acne scarring. It is only aimed at improving skin "texture" and "glow".

During the procedure, a handheld vacuum pump propels very finely ground crystals at the skin at very high speed and then collects them. The friction detaches some of the very outermost skin cells. Microdermabrasion goes about as deep as a light chemical peel.

Punch Excision: surgical removal of scar followed by suture.

Punch Elevation: center of scar (usually boxcar) is cut loose from the bottom, but is not discarded. It is allowed to float up to the level of the surrounding skin.

Punch Grafting: scar is removed and skin from elsewhere on the body, often from behind the ear, is attached in its place. This tends to work best for deep scars.

A 30-gauge needle, tattoo gun with no pigment, or needle-studded roller is used to puncture the skin at a controlled depth, inducing trauma which heals with collagen remodeling.

Steroids are injected into the raised scar. The steroids help interrupt the inflammatory response and the scar is reduced.

The scar is cut away and unbound from the tissue below, allowing blood to fill underneath and clot. This blood clot can help form connective tissue under the scar, thus leveling it with the surface.

Suction may be performed in the days and weeks afterward to reintroduce clotting and to acheive better results.

Subcision is often combined with resurfacing (dermabrasion or laser).

Topical scar treatments are largely ineffective, and usually achieve very little noticeable change even in minor scars. They include:

Prescription retinoic acid (Retin-A®): patient applies cream, gel, or liquid to scar twice daily.

Over-the-counter onion extract (Mederma®): buyer applies 3 times daily.

Over-the-counter silicone dressing: buyer applies silicone gel sheets are applied to scar. Sometimes pressure is also applied.

Over-the-counter Scarguard®: This is a combination of silicone and cortisone. Buyer brushes liquid onto scars twice a day.