Treatment of Acne Scars

“Saucer” or rolling type scars are the most common type of acne scar and have the appearance of small circular or oval depressions in the skin. These scars may be accentuated by redness or skin color change in the scar and by variations of lighting. Ice pick scars are small, sharp or pin-point type scars that penetrate deeply into the skin. Box car type scars are similar to ice-pick scars but the size of the box car scar is much larger and has the impression of a cut-out or a cookie cutter.

Hypertrophic scars or keloids are thickened, red or pink scars that are raised above the skin surface. Acne often leaves skin color changes such as skin lightening (or hypopigmentation), skin darkening (or hyperpigmentation) and redness of the skin.

There are multiple options for the treatment of acne scars. After your evaluation, Dr. Rostan and her staff will explain the different options to you and help you choose a treatment plan that best fits your condition and your goals. Often, a combination of treatments is best to help improve your acne scars and achieve your goal of smoother skin and improved appearance. Dr. Rostan and her staff have helped hundreds of patients with even the most challenging acne scars.

Laser Treatments

VBeam® Laser:
VBeam is a pulsed dye laser used to treat red scars and red marks often left behind after acne lesions. A series of 3-6 VBeam laser treatments can help speed healing and lightening of the redness. VBeam also stimulates collagen production in scars resulting in a smoother skin appearance and is helpful for thickened, hypertrophic or keloid scars.

The Smoothbeam laser is a non-ablative laser (meaning the laser does not alter the skin surface and thus there is no wound healing or downtime) that improves acne scars by stimulating renewal and remodeling below the scar surface. A series of laser treatments (6-12) is required, spaced three to four weeks apart. Smoothbeam has the additional advantage of being effective in reducing acne lesions.

Fraxel is a revolutionary new technology based on a new science of “fractional skin repair”. It can enhance the surface of scars as well as promote collagen production and remodeling under the skin, resulting in a smoother skin appearance. The Fraxel Re:Store® Laser is ideal for concave scars and is often combined with other treatments. The Fraxel Re:Pair® Laser may be used for more severe scars.

ThermaCool/Thermage treatment:
ThermaCool employs a patented radiofrequency (RF) technology to tighten and renew collagen, leaving smoother appearing skin. This tightening of skin results in an improved appearance of scars, which is further enhanced by collagen remodeling over time.

CO2 laser and erbium laser resurfacing:
For deeper, more extensive or predominately ice pick scars, laser resurfacing is often the best option. Scars are improved by immediate skin tightening, ablation of scar edges and collagen production and remodeling that occurs for 6-12 months after the procedure. This is a more invasive procedure with longer healing time (usually 2 weeks) and greater risks.

Surgical Treatments

This technique abrades the skin — improving the skin surface and stimulating collagen production below the scar as wound healing occurs. The erbium laser may be used in a manner similar to dermabrasion.

Punch excision/punch floating:
This technique is used for the treatment of box-car or sometimes larger ice pick type of scars. A small circular device is used to excise or cut out the acne scar, before a small suture is placed. Often this is combined with laser resurfacing, but may be used alone for scars that are likely not to respond well to laser treatment.

Subcision of acne scars:
A needle is used to disrupt and release the fibrous bands that attach to scars and pull down on the skin. The needle is passed under the scar to interrupt these bands and induce a wound healing reaction that can lead to collagen deposition.

TCA 90% for ice pick scars:
Very concentrated — 90% — trichloroacetic acid is applied to the base of ice pick scars using a tip of a wooden toothpick. This technique is often combined with other laser treatments for best results.

Filler Agents
Filler agents are injected into areas of acne scars in order to lift and fill the depressions. Results are best when used on larger concave scars or to refill areas where volume loss has accentuated the appearance of acne scars. Sculptra® is a poly-L-lactic acid filler that is most often used to fill soft tissue volume defects caused by acne scarring. More permanent agents include silicone and Bellafill®.