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Cosmetic Dermatology

Acne Scarring

What is acne scarring?

Acne is a common skin condition that affects millions of individuals worldwide, often leaving behind persistent scars that can significantly impact self-esteem and quality of life. Acne scarring occurs as a result of inflammation, tissue damage, and abnormal wound healing processes associated with severe or persistent acne lesions.

Acne scars can manifest in various forms, each with its own characteristics and appearance. The most common types of acne scars include:

  • Ice Pick Scars: Ice pick scars are deep, narrow depressions that extend into the skin, resembling small puncture marks or “ice pick” wounds. These scars are typically narrow and may be difficult to treat due to their depth.
  • Boxcar Scars: Boxcar scars are broad, shallow depressions with well-defined edges, resembling box-shaped craters on the skin’s surface. These scars often result from the loss of collagen and elastin in the skin and may be more responsive to treatment than ice pick scars.
  • Rolling Scars: Rolling scars are broad, shallow depressions with rounded or sloping edges, giving the skin a wavy or undulating appearance. These scars occur when fibrous bands of tissue form between the skin’s layers, tethering the skin and causing it to pull downward.
  • Hypertrophic Scars: Hypertrophic scars are raised, firm lesions that develop when excessive collagen production occurs during the healing process. These scars typically remain confined to the boundaries of the original wound and may gradually improve over time.

What are the treatment options for acne scarring?

Several treatment options are available for improving the appearance of acne scars and restoring smooth, healthy skin. The most effective approach depends on the type, severity, and location of the scars, as well as the individual’s skin type and treatment goals. Common treatment options for acne scarring include:

Topical treatments containing ingredients such as retinoids, vitamin C, hydroxy acids, and peptides can help improve skin texture, reduce hyperpigmentation, and stimulate collagen production, leading to gradual improvement in the appearance of acne scars.

Chemical peels use agents, such as alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), and trichloroacetic acid (TCA), to remove the outermost layer of damaged skin cells and stimulate collagen production. Superficial to medium-depth peels can help improve the appearance of mild to moderate acne scars and hyperpigmentation over larger areas, resulting in smoother, more even-toned skin. High potency peels can be used to spot-treat depressed acne scars (TCA cross technique)

Microneedling involves the use of a device with fine sterile needles to create controlled micro-injuries in the skin, triggering the production of collagen and elastin. This process helps improve skin texture, reduce the appearance of acne scars, and enhance overall skin quality.

In some cases, surgical techniques such as punch excision, punch elevation, or subcision may be recommended to physically remove or elevate depressed acne scars and release tethered scar tissue, resulting in smoother, more even skin texture.

Injectable fillers, such as hyaluronic acid fillers, can temporarily fill in depressed acne scars, restoring volume and smoothness to the skin’s surface. These fillers provide immediate results and can last several months to years, depending on the type of filler used.

Laser and light-based therapies, such as fractional laser resurfacing, microneedling with radiofrequency, and intense pulsed light (IPL) therapy, can help stimulate collagen production, improve skin texture, and reduce the appearance of acne scars. These treatments target the deeper layers of the skin, triggering the body’s natural healing response and promoting the regeneration of healthy, scar-free skin.

At a Glance

Dr. Thomas Knackstedt

  • Double board certified in dermatology and Mohs Surgery
  • Over ten years of experience providing evidence-based care
  • Nationally renowned physician leader with numerous publications, lectures, and academic affiliations
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