Acne Scar Removal

One of the most common questions confronted in dermatology offices amongst patients with acne is how to get rid of acne scarring. This is such an important question because, as acne has its own problems, occasionally the resulting acne scarring can be as cosmetically disturbing as the original acne. Many advances have been made to alleviate the appearance of acne scarring, but no over-the-counter remedies are currently available. The following discussion and suggestions must be carefully reviewed with your experienced dermatologist.

The first step in the treatment of acne scarring is treating the underlying acne. Without an effective acne scar removal regimen, treating acne scarring will be futile as more scars will occur despite treatments.

Your regimen may include simple over-the-counter acne care or prescription topicals such as Retin-A or Tazorac. Other treatment options include antibiotics, Blu-Light Photodynamic therapy, and oral isotretinoin therapy. These choices are made between you and your experienced dermatologist.

Acne scarring can be divided into two primary groups: rolling acne scars and ice-pick scars. Rolling scars are best described as hills and valley that are truly accentuated with tangential lighting. Ice-pick scarring is the sharp, deep pitting holes made as if an ice-pick was poked into the skin. The treatment of these two different types of scarring differs in both the methods used and the rate of success.

For rolling scars, there are surgical, ablative, and non-ablative methods for acne scar removal. Surgical methods include subcision treatment where a needle/blade is placed underneath the scar and moved side to side to loosen up the underlying scarred tissue. Another treatment option is using a filler such as Restylane® or medical grade silicone to fill up the scar. Non-ablative therapies include using an infrared laser to heat up and remodel the tissue underlying the scar. Ablative therapies include dermabrasion (manual sanding of the skin) or ablative lasers, such as the Er:YAG or CO2 lasers, to remove the top layers of the skin and essentially even out the “hill-tops and valleys” of the rolling scars. Newer laser treatments include the use of fractional resurfacing laser technology (Fraxel, Starlux). The data is still quite new, but these lasers appear to combine excellent efficacy with minimal downtime.

For ice-pick scarring, surgical methods include punch excision, where a cookie-cutter circular instrument is used to remove the scar under anesthesia and a stitch may or may not be placed to help with healing. Another new technique involves using 90% Trichloroacetic Acid applied with a toothpick. This serves to damage the skin within the scar and promote scar remodeling. The other acne scar treatment methods mentioned above also apply: use of the filler substances, dermabrasion, and laser resurfacing.

In general, non-ablative laser therapy may reasonably lead to 50-70% improvement of rolling acne scars. Subcision and use of fillers are ideally used for limited rolling acne scarring and punch excision treatment may be used if isolated ice-pick scarring is noted. For more extensive scarring of either type, dermabrasion or ablative laser therapy tends to be the best option.

Many of these treatments are skin-type specific and must be determined upon close consultation with your dermatologist. While these treatments are not covered under any insurance, the cosmetic results may be well-worth the price. Make sure to discuss all the possible therapy options and combinations, as well as the reasonably expected results.


Potential Treatments

Scars are the result of tissue remodeling after skin injury. Acne scars are typically seen along the cheeks and chin in acne-prone individuals even after successful acne treatment. Acne scars are seen in two primary varieties: rolling scars and ice-pick scars. Rolling acne scars are shallow and mild “hills and valleys” seen mainly on the cheeks. Ice-pick scars are the deeper, focal, square and angulated scars. The treatment for rolling acne scars includes dermabrasion, infrared laser therapy, surgical subcision, and injectable fillers such as Restylane®, collagen, or silicone. The treatment for ice-pick scarring includes punch excision as the primary mode of therapy followed by 80-90% trichloroacetic acid and the other modalities listed for rolling scars.

Laser treatments have been used for acne with variable success. The non-ablative lasers (do not peel off the skin) have variable results and are best suited for those patients with slightly noticeable rolling acne scars. The ablative lasers (peel off the top layer of skin) are the gold standard for all types of acne scarring, but have significant downtime. Newer laser treatments include the use of fractional resurfacing laser technology (Fraxel®, Starlux®).

Other regular scars on the body can be benefited by different means. While a scar is meant to last forever, unsightly scars may be surgically revised by your dermatologist or plastic surgeon. Topical treatments, such as silicone gel sheets and mederma, are numerous and are met with variable success.

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