What Treatment Options Are There for Depressed Acne Scars?
Doctor Answers 8
Options for Depressed Acne Scars
Hi Cosmetic. There are many options for the revision of acne scars and in many cases, the best options involve a range of treatments. You should go to several consultations with experienced practitioners that use one or more of the following programs to treat acne scars.
- Traditional CO2 laser resurfacing
- Traditional Erbium Laser Resurfacing
- Fractional CO2 or Fractional Erbium laser resurfacing
Depressed acne scars
Treatment Options for Depressed Acne Scars
There are several different modalities for treating different types of acne scars including filler, resurfacing techniques, laser, punch excision and subcision. Depressed acne scars tend to do very well with filler. In our office, we use liquid injectable silicone (LIS, Silikon 1000) to fill acne scars at is precise and permanent, yielding the best filler results. Sometimes I also use light electrocautery to smooth out the edges of the scar after filling them with LIS. I recommend you consult a board-certified dermatologist to evaluate your scars and decide which treatment options will give you the best results.
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Our approach to the management of depressed acne scars is a multi-step process: The patient must be committed to complying with all aspects of treatment if they are to achieve optimal results. In those that do, the results can be good to excellent. To begin with, the patient must abide by a skincare regimen that will optimize their skin health and allow for maximal regeneration and neo-collagenesis. This is accomplished by both topical skincare products as well as oral nutriceauticals. Secondly, I utilized collagen-induction therapy. The procedure can be performed either awake, under sedation, or under a general anesthetic. The downtime is minimal to modest, and the procedure is effective in addressing the deepest layers of the skin. Lastly, in patients whose skin-type is amenable, I prefer the Encore Lumenis Active/Deep FX fractionated CO2 laser treatment. Typically, two treatment sessions are necessary to achieve optimal results. In those patients with darker skin types, I utilize a Fraxel ReStore Treatment Series, typically totaling 5 laser resurfacing sessions. Results will not be fully realized for at least 12-18 months, thus patients must be educated that patience is of essence, and a continued commitment to a skincare protocol is requisite during the "healing" process.
Glenn Vallecillos, MD, FACS
Diplomate, American Board of Plastic Surgery
Beverly Hills, CA
Depressed acne scars need more aggressive therapies
After 26 years of treating severe acne scars, I can advise you of these facts: 1. superficial treatments like microdermabrasion and most chemical peels help discolored scars more than depressed scars. 2. True resurfacing with either traditional dermabrasion or CO2, or perhaps aggressive erbium laser or several sessions with Fraxel Restore are the best options for long-term improvement. 3. Fillers like Radiesse combined with some degree of subsicion is a reasonable alternative, but will not last as long.
Reducing acne scars on the face
There are many options for treating acne scars on the face. First, a good skin care regimen and routine maintenance with peels or microdermabrasion are important. These simple treatments will help smooth the skin and increase skin surface cell turnover, which improves skin texture.
For deeper scars, you might try a deeper peel or even some types of laser resurfacing, which would have a little downtime (few days) associated with them. Fillers can be used for some types of scars, but not all.
I know this answer is a bit vague, but scars are very individual, and what works for one person may not be as effective for another. Your best bet is to have a personal consultation with a plastic surgeon or dermatologist who deals with scarring regularly and has multiple treatment options available.
In general, there are alot of options available when it comes to scar revision; sunscreen, camouflage make-up, topical medications/creams/bleaches/peeling agents, silicone gel or sheeting, microdermabrasion, chemical peels, collagen injections, subcutaneous fillers (fillers, grafts, implants), tattoo, dermabrasion, laser resurfacing/ablation/treatment, scar revision surgery, etc. These can be administered by the patient, nurse, and/or doctor.
Specifically, management of Acne scars can be a difficult undertaking and is generally aimed at reducing/altering rather than eliminating the visible scars. Many procedures have been described but there is no " wonder cure." Please read on for a description of the various options.
Please see our website for a description of the procedures.
An office visit/consultation is mandatory prior to scheduling any treatments: For example, many conditions can be managed by an aesthetician. Micropeels can improve scarring and pigmentation secondary to acne depending on the extent, severity, and depth of scarring/pigmentation. Other procedures such as microdermabrasion can also help.
In other instances, more aggressive treatment may be warranted. For example, the following information is based on dermabrasion and the laser resurfacing procedures. During the consultation we may determine that other procedures are better suited for your optimal outcome.
Treatment of darker complexions: olive (mediterranean descent), hispanic, asian, black, etc. has a higher risk of post-operative hyperpigmentation (darkening or blotchiness) and erythema/hyperemia (redness) when compared to a fair complexion (typically northern european). I oftentimes will try a test area to asses an individual's responses to healing. In some darker skin individuals, I have found that I get a better response with dermabrasion. Again, I recommend performing a test patch in the high forehead or cheek regions to assess the individuals response to treatment. Multiple treatments may be required and will have to be spaced at least 4 months apart. It is extremely important that you avoid sun exposure with any technique post-operatively.
In some cases, I recommend the Coherent Ultrapulse CO2 Laser. Other lasers are available. The procedure takes about 1 hour and is performed on an outpatient basis. Additional treatments my be required.
There are risks to crossing the street or flying in an airplane and, of course, there are risks to any surgical procedure. These risks can occur regardless of surgeon or technique. These include but are not limited to: infection, discomfort, wound breakdown, hypertrophic scar formation, unfavorable healing, irregular pigmentation (darkening or lightening), prolonged redness, need for secondary surgical revisions, and inabiltity to guarantee a specific cosmetic result.
The face is washed every 3 hours the first day, 4 hours the second day, 6 hours the third day and 9 hours thereafter until completely healed. Certain dressings may be required during the 7-10 days following the procedure.
Treatment for scars
There are a number of possible treatments for depressed scars. I prefer a long term approach. Exfoliation and skin resurfacing are a common theme. These can be achieved with chemical peels, laser, and dermabrasion, depending on skin tone. Some use fillers to "plump out" depressions. I have had little success with this technique. Lasering is more difficult in patients of color as it may lead to hyperpigmentation. I prefer staged chemical peels, Retin-A, and dermabrasion.