How Can I Remove Old Acne Scars on my Forehead?

Acne scarring is a very difficult situation to treat.  There are many different types of acne scars.  Some are deep and they may need to be excised, while some are superficial and may respond to the CO2 or fraxel laser. Fraxel treatment is able to precisely treat thousands of microscopic areas of skin, using pinpoint laser beams that penetrate beneath the skin's surface to stimulate new collagen growth.  With the CO2 laser the damaged skin is replaced with fresh, healthy skin.  Unfortunately, flat, white scars are not treated easily.  The only possibilities are to excise them or add pigmentation through a tattooing procedure.  Consult  your plastic surgeon to see what is the best option for your skin.

Our office has many different treatments for acne scars depending on the depth of atrophy or hypertrophy. Acne scars require a combination approach using our HI DEF protocol which uses a combination of lasers, topical scar modulation, and RF treatments to pixelate scars, improve contour, reduce hyperpigmentation, and improve the visibility of the scars so that they are no longer visible in ambient light. Everyone has a unique pattern of acne scarring and we employ our HIDEF technique to improve texture, color, contour, and topography. We often use a combination of treatments that begin with a careful examination to examine the micro texturing of the acne scars. Atrophic acne scars and indented acne scars can benefit from injectable fillers such as Radiesse, Sculptra, and Restylane with or without subcision to remove tethered scars and atrophic depression. Hyper-redness in scars can be been improved with V beam laser, Excel V, BBL, IPL, and Venus RF to improve the redness and reduce the visibility of deep scars. Fractional Thulium laser and clear & brilliant can also reduce the inflammation and redness of the scar when combined with topical therapy. Fractional laser such as Fraxel, erbium, and CO2 laser can be combined with radio frequency and also fractional RF to improve textual issues and microtopography. Subcision and TCA cross are also used for deep ice pick scars and narrow valley scars in order to improve the micro texture. Above all, our combination approach with our clinical nurses and board-certified plastic surgeons can improve the quality of your skin by using at home Melarase creams combined with PRP treatments in our office to improve your skin quality and tone. I recommend getting a formal evaluation with an experienced team of experts in order to reduce your acne scarring.

Finally, hyperpigmentation of scars can be improved with at-home Melarase AM, Melarase PM, and Melapads to help reduce active PIH and melanin deposition.

Best,
Dr. Karamanoukian
Realself100 Surgeon

An acne scar is a depressed scar with the skin anchored to the deep tissue.  The best treatment is to excise the scar and exchange it for a linear scar that is flush with the skin.  Since the new scar is not depressed it does not cast a shadow and can be covered with makeup.

Hi Icks.  If your concern is the lightening (whiteness) associated with your old acne scars, this is difficult to revise.  Typically once the pigment is removed from the skin, it is difficult to get it back.  

If you concern has to do with texture (even though you say they are "flat"), you may want to consider one of the following:


Traditional CO2 or Erbium Laser Resurfacing

Fractional CO2 or Erbium Laser Resurfacing


It is possible that if you have deep fractional resurfacing that you may have some repigmentation of the white areas.  We would set very low expectations regarding the possibility of this.

Dear Icks - thanks for your question - a quick note on scarring - a scar attracts the eye because of a color change from surrounding tissue (such as white in your case or dark pigment in others) or because of an architectural difference (in example, a pox mark which is depressed or a keloid which is elevated).  The type of scar dictates the treatment modality or method that is best.  In your situation I would agree with Dr. Kaplan who indicates that a light scar without depression or elevation (flat) is difficult to address.  The best that one can do in this situation is to try to lighten the surrounding tissues with either a skin routine including a bleaching agent or an acid peel/laser peel to again decrease color difference.  Finally, many new products on the market may provide provide you cover without the heavy make-up appearance.

Depending on the type of scar, my recommendation is that it's very important to see a dermatologist who specializes in scar revision and specifically in treating acne scars.


Some people are good candidates for fractional CO2 laser resurfacing with a machine such as the SmartXide DOT or the SmartSkin.  Somestimes filler, such as Restylane or Juvederm, or a technique called subscision is helpful.
 

For deeper scars (i.e., ice pick scars), you could consider the Cross technique, where TCA (acid) is meticulously placed within the pits of the scar to re-"wound" them in a controlled manner.  This will stimulate your body to make new collagen.  This procedure may need to be repeated several times.


Best idea is to consult with an experienced dermatologist because the nature of every scar is different.

While the dark areas of pigmentation can be treated relatively easily, inexpensively and non-invasively with intense pulsed light therapy, the flat, white scars may be more problematic.  Many times (although not always), flat, white scars may indicate abnormal scar formation or hypertrophic scarring. Simply put, hypertrophic scarring occurs when the body's own healing system runs on overdrive ~ it doesn't "turn off" when it should.  When this happens once, it can happen again if the skin is traumatized.  Hypertrophic scarring is much more definitively diagnosed in person, as opposed to by photograph and you may not have it.  However, IF your flat, white acne scars are in fact hypertrophic scarring, then my advice is NOT to do any procedures that would cut, burn or resurface the skin!

There are different kinds of acne scars. Some are deeper than others. This would determine the ideal treatment. For more superficial acne scars good results can be obtained with fraxel or Ematrix. Most patients need multiple treatments for best clinical outcome. Treatments are usually once every 4-6 weeks.
For deeper scars, one may consider fractional co2 Laser. This does require at least a week of downtime as it is a much more aggressive treatment. This too can require a few treatments.

There is not a good treatment for flat white scars. Some reports have shown improvement after fraxel laser but there is not complete reversal. One approach is to lighten the surrounding darker skin, if present, with a laser that helps with pigment such as Fraxel, IPL or alexandrite laser (like gentlelase). Chemical peels may also help even out skin tone but will not repigment white scars.