What kind of acne scars are these and what are the best procedures to treat? (Photos)

Question

I have these scars on my face - I'm not sure what the cause. I'm referring to the wavy texture parts and not the ice pick scars. I can only see them under certain lightings. What caused it and what are the most effective treatment/procedures for it?

Raffy Karamanoukian, MD, FACS · Answer

Acne scars are usually characterized within the subtypes of atrophic, hypertrophic, pigmented, or inflammatory. These subtypes of acne scars can be visually discerning in ambient light and can cause significant cosmetic concerns. Indented and atrophic scars require a combination approach to stimulate collagen and elastin, thereby smoothing contour and uneven skin. These are usually combined with lasers and depigmentation protocols to reduce inflammatory hyperpigmentation (Melarase AM and Melarase PM). Our Hidef protocols for acne scars include fillers such as Sculptra, Juvederm, Radiesse, and Restylane to improve deep acne scars; Vascular lasers to reduce inflammation and post-inflammatory redness and erythema; Fractional lasers to smooth contour and collagen; and Fractional RF to stimulate production of collagen within atrophic scars. Textural improvement and superficial scarring can be improved with Cosmelan peels, TCA Cross for ice-pick scars, deep chemical peels, and fractional CO2. We offer a personalized approach to your combination of scars and a formal evaluation with consultation is recommended to help you achieve your final results. Our plastic surgery office offers subcision and combination TCA Cross to help reduce deeply pitted scars. In terms of pigmentation and skin resonance, we recommend daily use of Melarase AM and Melarase PM coupled with Retinoid creams to achieve brilliant skin.

Best, 
Dr. Raffy Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

At least from the photos provided, the "wavy" scars you see are actually fairly superficial, multiple slightly indented acne rolling scars. That's what accounts for the wavy appearance you see, particularly in side lighting.
Prior active acne inflammation at each site caused destruction of normal skin tissue and when each site healed, it healed with atrophy, I.e. scar tissue that pulls the surface of skin down to form these kinds of scars, and in other people can give rise to boxcar scars and Ice pick scars, and in most cases all three kinds of scars. As a rule, most acne scars are of the ice pick variety, the remainder a mix of boxcar and rolling scars.
Subcision, which I have been performing now for thirty years, works well for individually elevating and smoothing Indented sars of all kinds, including acne rolling and boxcar scars. . Field Subcision is a widespread subcision, which would be performed under the cheek in this case, intended to elevate and smooth all of the overlying shallow rolling scars, and would appear to be a very viable treatment option here. 
Since, unfortunately, so many treatment venues these days are heavily involved in hawking the expensive, supposedly "next big thing" light or energy-based gizmos, like fraxels and RF devices, it may be hard to find a specialist willing to or experienced enough to perform subcisions. So, make sure to do your due diligence before going ahead with a treatment with these.
Hope this helps and best of luck.

What kind of acne scars are these and what are the best procedures to treat? (Photos)

Answers (2)

Recommended reading

Everything you need to know about Laser Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.

What kind of acne scars are these and what are the best procedures to treat? (Photos)

Answers (2)

Browse related questions

Recommended reading

Everything you need to know about Laser Scar Removal

Our mission is to create a world where every investment in modern beauty is Worth It.