The Best Acne Scar Removal Procedures that Dermatologists Recommend

Part 1: Acne Scar Formation and Treatments for Raised Acne Scars

Acne scars are a common problem among teens and adults and often require the dermatologist’s attention. They blemish otherwise healthy skin and, for some, affect their self-esteem. Nobody wants to be too shy to post selfies on the internet because of these flaws.

At BHSKin Dermatology, our skin experts specialize in a myriad of acne scar removal treatments for every patient and skin type. They can help you solve this problem safely and effortlessly.

In this article, we begin a two-part series on the various procedures used for clearing pimple scars. We start by explaining how they form and their different types. Each kind is approached differently, so we first talk about the best treatments for raised scars.

How Do Acne Scars Form?

The skin can heal itself from injuries, such as an acne breakout, but the process is often imperfect. Scarring results from collagen fibers replacing cells that cannot grow back or are slow to do so. The scar’s final form depends on the interplay of various factors.

For example, the following events dictate acne severity and the extent of scarring:

• Stress, hormones, medications, poor hygiene, poor nutrition, etc. can raise one’s proneness to pimple formation. These can lead to the following changes in the hair follicles:
  • The oil glands become more active.
  • Oily secretions change in quality.
  • Testosterone-like hormones rise or become more active in the follicles.
  • Dead skin cells, oil and debris accumulate in the follicles.
• The microbe Propionibacterium acnes can aggravate the above changes by infecting the hair follicles. It can produce irritants from the skin’s oily secretions. Infection may result in follicular inflammation and swelling.
• Swollen follicles can form abscesses and rupture, which is what we see as active acne.
• Severe acne develops if more follicles are involved or the abscesses are widespread. Some individuals require aggressive acne treatment to curb the inflammation.

Immune cells wall off the infection and clear it up. Healing begins afterward. The repair mechanisms involved determine the kind of scar produced.

• The platelets release various growth factors that induce the formation of new blood vessels and skin tissue.
• Collagen, elastin and other connective tissues also regenerate. Collagen is the most abundant connective tissue in the skin, and its content influences the kind of acne scar formed.
• After the repair phase, connective tissues, especially collagen, continue to “remodel.” Remodeling reorganizes and strengthens collagen fibers, and it can take months to years.
• During remodeling, molecules called “matrix metalloproteinases” (MMPs) digest some of the collagen formed. MMP inhibitors keep them from dissolving all the collagen. Genetics influences the dominance of these molecules.
• If MMP action prevails, more collagen is digested, and a depressed scar, also known as an “atrophic scar,” is created.
• If inhibitor action predominates, collagen production exceeds its destruction, producing a raised scar. A raised scar can be a hypertrophic scar or a keloid.
• A balance between the two groups of molecules produces flat or “normotrophic” scars. These lesions may have lighter or darker pigmentation.
• Dermatologists approach raised and depressed acne scars differently. In this article, we limit our discussion to the best treatments for raised scars.

What Are the Best Ways to Get Rid of a Raised Acne Scar?

Hypertrophic scars and keloids both have excess collagen, which puffs up the dermis and elevates the skin’s surface. They differ based on their extent—hypertrophic scars grow only within the skin injury’s borders while keloids expand beyond. Both lesions are more common among individuals with darker skin.

The treatment goals are similar: reducing the scar and making it look more like the healthier surrounding skin. Your dermatologist will work with you in determining which of the treatments below suits you best.

Silicone Gel

Silicone-based products are the first-line treatment for raised acne scars. They reduce the lesion by the following actions:

• Activating the immune system
• Hydrating and warming the scar
• Increasing the scar’s oxygen content
• Normalizing collagen production

Skinstyle’s Silagen Scar Refinement System is a dermatologist-recommended silicone gel formulation that you can use at home. Unlike other silicone-based treatments, it has UV protection as an added advantage.

After cleaning and drying the scarred skin, you can apply it twice a day for at least 8 weeks or as directed by your dermatologist. Rare side effects are hypersensitivity and skin maceration. Silicone gel is safe for pregnant women.

Intralesional Steroid Therapy

Intralesional injections of a steroid, usually triamcinolone, reduces inflammation, blood vessel size and collagen growth in the scar tissue. The specialist may combine this procedure with another acne scar treatment.

Before the Treatment

No pretreatment is usually necessary.

During the Treatment

The dermatologist will clean up the scarred skin and inject the steroid in it several times. This may cause discomfort, although painkillers are normally not required. The session takes only a few minutes.

After the Treatment

The procedure requires no downtime. Patients usually need multiple sessions. The most common side effects of intralesional steroid injections are pain, bruising and redness. Call your doctor for signs of infection (e. g., fever or pus).

Aftercare:

• Keep the site clean at all times.
• Plaster is not needed unless bleeding occurs.

Microneedling with PRP

Raised scars have abnormal blood vessel and collagen formation underneath the skin’s surface. Microneedling breaks up tough collagen fibers. On its own, it can trigger the healing process anew, forming fresh layers of skin cells, collagen, elastin, blood vessels and other tissues. Dermatologists sometimes combine it with other treatments to manage complex skin conditions.

Platelet-rich plasma (PRP) is the liquid portion of the blood rich in growth factors. It helps speed up the repair process and ensure normal connective tissue and blood vessel growth. Applying topically or injecting PRP into a microneedled scar improves the lesion’s appearance.

Before the Treatment

Your specialist may ask you to do the following:

• Avoid medications that can decrease your blood’s ability to clot, such as aspirin, clopidogrel, warfarin, etc.
• Skip treatments that can make your skin overly sensitive, like sun tanning and vitamin-A-containing medications.
• If you have a chronic medical condition, get medical clearance to ensure that this therapy is right for you.

During the Treatment

Your dermatologist will draw a small amount of blood from your arm. A spinning machine called a “centrifuge” shall be used to separate the PRP from other blood components. The doctor will then use a microneedling instrument on the acne scar before applying or injecting the PRP.

The procedure can take up to 30 minutes. A numbing cream will be applied on the site beforehand to make it painless.

After the Treatment

The downtime is minimal. Multiple sessions are required. The most common side effects of microneedling with PRP are flushing, swelling and mild discomfort. Some may notice pinpoint bleeding, hypersensitivity and bruising. Call your doctor if you experience excessive bleeding, intolerable pain and signs of infection.

Aftercare:

• Avoid scratching the site.
• Use mild cleansers and sunscreen. Protect the treated area from harsh chemicals.
• Avoid vigorous activities, which will cause you to sweat and itch.

Vbeam Laser

Acne scar removal is done by using a non-ablative laser. The powerful light beam will destroy the malformed blood vessels in the scar tissue, causing it to shrink.

Before the Treatment

Your doctor may advise you to do the following:

• Avoid sun exposure, chemical peels, vitamin-A-containing medications and other therapies that can increase your skin’s light sensitivity.
• Avoid taking vitamin E and blood thinners, which may increase the risk of bruising or bleeding.
• Stop smoking for at least 2 weeks.
• Take cold sore medication, because the procedure can trigger cold sores in vulnerable patients.

During the Treatment

You will be given eye protectors to wear during your session. The instrument will spray a cold mist on your skin, making the procedure essentially painless. The doctor will deliver laser beams in pulses on the acne scar. The session may last 15 minutes.

After the Treatment

The downtime after Vbeam laser treatment is minimal. You may notice redness and swelling in the first 24-28 hours, but these normally go away on their own. Some individuals experience tenderness for about 2 weeks, but this is usually tolerable.

Acne scar treatment by laser typically requires multiple sessions. The usual side effects are redness and swelling. Bruising, itching, discoloration and aggravation of scarring are less common. Call your dermatologist for intolerable side effects.

Aftercare:

• Avoid sun exposure on the treated area to prevent repeat scarring.
• Drinking plenty of fluids will help you excrete the breakdown products created by Vbeam laser treatment.
• Keep the area clean and dry.

Minor Surgery

The doctor will cut away the damaged skin and reconstruct the remaining tissue to enhance the scar’s appearance.

Before the Treatment

Surgical incisions can worsen some medical conditions, so it is not for everyone. Your doctor may ask you to get a medical clearance and avoid some drugs, e. g. aspirin and other blood thinners, before the session.

During the Treatment

Your dermatologist will clean up the area and inject some numbing medication into it. The doctor will then manually reconstruct the scarred skin. The procedure can take up to 30 minutes.

After the Treatment

The downtime may take 1-2 weeks because the initial healing phase produces moderate swelling and pain. Surgery is used on larger acne scars, and only one session is typically required. More may be done depending on the problem severity. Call your doctor if you experience severe pain, excessive bleeding or signs of infection.

Aftercare:

• Your dermatologist will teach you how to care for the wound at home.
• You may need oral painkillers for 1-2 weeks.

In the next article, we shall focus on the different treatments for normotrophic and atrophic scars and sum up our series.

Let the Award-Winning LA Skin Specialists Erase Those Acne Scars!

Acne scars, especially those appearing on exposed body parts, can be a hassle. They make you spend more money and time on concealers or keep you from showing off that toned body at beach parties.

At BHSkin Dermatology, removing acne scars is a cinch. Our board-certified dermatologists can clear your skin expertly and make it look like those flaws were never there. Visit us today at our Encino or Glendale clinic. You may also use our virtual portal to consult with our doctors wherever you are.

Book your appointment now and get your friends admiring your flawless skin in no time!

Author: Don Mehrabi

Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online