How to Get Rid of Acne Scars?
Doctor Answers 42
Treatment of Severe Acne Scars
Acne scars are varied and complex and their treatment requires a comprehensive and detailed approach. Rarely does one laser or treatment method suffice. I think the four most important considerations are the following: (1) Are the scars atrophic or depressed? Does the patient require filler or fat to correct contour depressions in the skin? (2) Are the scars strongly tethered or bound-down to the deeper tissue? If so, subcision (needle release of the scars) might be needed to "free" the scars from deeper tissue before attempting to place fat or fill to correct their flattened contour (3) Does the patient require new collagen and elastin in the dermis to restore the skins thickness and elasticity? If so, deep fractional lasers and needle-based radiofrequency (RF) treatments can be very helpful. (4) Finally, are the scars discolored (pigment or redness)? If so, vascular lasers, pigment lasers, and/or bleaching creams might be needed to eliminate stubborn pigment or redness caused by chronic inflammation. Experienced clinical judgement and a wide array of technology is needed to select the proper treatment plan depending on the patient's age, skin type, scar pattern and lifestyle.
Rid of acne scarring
Acne scars can be a very troubling problem. Even though the acne breakouts may be controlled or have long since stopped, the scarring remains for a lifetime.
Treatment for acne can be as troublesome as the disease itself. Usually, successful treatment requires a team approach with a dermatologist and a cosmetic surgeon.
First, attention must be turned to stopping any outbreaks, then repair of the scarring. If outbreaks continue, scarring is likely to continue, and any treatments aimed at treating scarring would be futile. There are many options for treatment of acne today depending on the severity of outbreaks. These are beyond the scope of this article, except to say that treatment for the underlying disease process is a must. Once the outbreaks are well controlled, attention can be turned toward erasing the lasting marks on the face.
Of note, acne is not only a disease of adolescence. Adult onset acne is not completely uncommon and is seen in women who are pregnant – often with more severe scarring. Treatment options for acne scars depend on the severity of the scarring and the skin type of the person wishing repair.
In people with darker skin, Fitzpatrick Types V, VI; options are limited because of concern for pigment irregularities after treatment. For lighter skinned individuals, treatments range from simple facial exfoliation to deep chemical or laser peels to surgical intervention.
For light scarring after acne, attention is placed on skin resurfacing. By taking off the outer layers of skin and stimulating collagen synthesis with new skin formation, acne scars can be reduced. This is best simulated by placing a finger on either side of an area of scarring and lightly pulling. If the scars fade, this can be a good option for resurfacing.
For deeper scars, a deep chemical peel, ablative laser (CO2 or erbium) resurfacing, or dermabrasion/dermasanding may be necessary. For deeper scars, deeper solutions are necessary. Again, several options exist.
- Deeper scars can be surgically excised with the larger acne scar replaced with a surgically placed small line. This can later be refined with other rejuvenation techniques.
- Punch grafting affords a simple method for treating multiple scars. A circular punch is used to create an incision around an acne scar. The scar is then allowed to heal and the resulting skin irregularity is smoothed.
- Subcision involves releasing the tethering attachments underneath the scar and then filling the space with either a temporary or permanent filler to prevent the scar from reforming when it heals. With the advent of new temporary artificial fillers such as hyaluronic acid, this is a good option for larger depressed scars.
Whatever the treatment option, it is important to consult a physician with a large arsenal of treatment options – if a physician only sells a cheeseburger, then you get sold a cheeseburger, even if you need a bacon burger. It is also important to remember that just as acne scars did not form overnight, treatment can sometimes take months to get the desired result. Once you find an experienced physician and decide on a treatment option, remember that it’s a long road but one that is usually worth the wait.
Erbium and CO2 lasers treat acne scars well
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ProFractional Therapy for acne scars
Acne Scar Treatments
- Microdermabrasion can be likened to a "superficial skin polishing" using micro crystals vacuumed through a delicate hand piece. In as little as 20 minutes, this gentle abrasive technique efficiently produces satisfying results. Treatments are progressive and are applied through a course of weekly sessions. Often not sufficient for most acne scars as it does not go deep enough. Dermabrasion, which abrades the top layer of skin down to the dermis, is more effective for atrophic scarring.
- Microneedling uses acupuncture-like needles to pierce the skin. These “micro-injuries” cause the controlled start of the skin’s self-repair mechanism, which triggers new collagen production without the risk of permanent scarring. The result is typically smoother, firmer looking skin. Skin needling procedures are performed in a safe and precise manner with the use of a sterile Micropen needle head.
- Chemical peels cause the skin to exfoliate and produce fresh new skin cells. There are different peels of varying strengths based on the results that you want. Usually 3-5 peels will be needed. Often not sufficient for most scarring as these typically do not work deep enough. A stronger chemical peel, 100% TCA used in a “cross hatch” technique, is an effective treatment for “ice pick” scarring.
- Dermal filler injections are good for shallow and deep scars. These fillers can be injected into the area of the scar, smoothing depressions. Results are immediately apparent. Bellafill, a long lasting filler, is now FDA approved for these treatments. Also high grade silicone can be an effective treatment when used properly.
- Subcision is a technique that breaks apart the scar tissue under depressed scars with a special needle. New tissue is created that raises the scar or unwanted depression.
- Non-Ablative laser treatments are not painful and there is no downtime. Most patients receive a series of about 5 treatments. Benefit from this type of laser is usually subtle. (i.e. the improvement is gradual).
- Fractional skin resurfacing treats facial scars by delivering the laser's energy in microbeams and is an effective treatment for many types of acne. Fractional treatments promote the production of softer, smoother skin.
- Laser resurfacing (fully ablative laser) is less commonly utilized these days. It is typically considered an aggressive treatment for acne scarring. It can, produce dramatic improvements, but comes with significantly longer downtime and a greater risk of post laser scarring and or redness.
How to get rid of acne scars
Acne scars can cause red or brown discoloration and uneven skin contour. Usually multiple types of treatments are needed for maximum improvement. Patience is key since the full effect is often not seen for several months.
Skin discoloration and texture can be improved with topical treatments like hydroquinone and Retin-A, but for deeper scars and more significant discoloration, other techniques are needed.
Small, deep acne scars can be treated with surgical excision, which will ideally trade a depressed and discolored scar for a thin, flat scar.This is often followed by other resurfacing techniques like laser, chemical peel or dermabrasion to further smooth the skin and minimize scarring.
Other techniques to improve large or numerous scars involve resurfacing the skin by intentionally traumatizing it in order to stimulate collagen production. This thickens the skin and shrinks the surface area of the scar, and color may be improved as well. The Cross technique uses a very concentrated TCA peel. There are multiple types of laser as well, and the best choice depends on the degree of improvement needed as well as your skin color. Unfortunately options are limited for patients with dark skin due to an increased risk of skin discoloration.
Risks for all these techniques include temporary or permanent lightening or darkening of treated skin, crusting, scabbing, persistent or new scarring, reactivation of cold sores, infection, redness, acne flares, and milia formation.
Getting rid of acne scars
There are generally three viable alternatives that we utilize on a regular basis:
- Erbium Laser which generally works with one treatment, but can be repeated if desired.
- Fraxel Laser which generally provides some improvement after 5 or 6 treatments.
- Injectables to fill the acne scars. This provides temporary but quick improvement of acne scars.
With any of these alternatives, you should find an experienced practitioner who is well trained.
Best options to get rid of acne scars
Acne scars come in several different depths and sizes. It's difficult to remove 100% of an acne scar but you can make it significantly better. A combination of treatments is ideal but it can definitely add to the cost. If you have the funds, the best way to treat acne scars are as follows:
1. First, start on topical Retin-A to start improving cell turnover and collagen deposition and use this for at least 3 weeks before doing the below. Once the treatments below are finished, restart Retin-A (have to use Retin-A in the evening followed by a good medical sunblock the next morning).
2. Next, surgically excise the deep ice pick scars; this can be done in the office under local...don't have to do all of these at the same time but the sooner you do it, the sooner you can move to the next step.
3. Then, add Bellafill with a combination of subcision (most doctors who do Bellafill usually do subcision at the same time). Technically speaking, you can start this with the surgical excision sessions.
4. About 6-8 weeks later, have the scars lasered using a fractionated CO2 laser system (can't do this if you have darker skin or tan easily).
5. About 6-8 weeks later, start professional dermapen (microneedling) and have at least 5-6 sessions.
The above combination can give you almost a 70-80% improvement (sometimes more) in overall acne scarring. Not everybody needs every treatment, and sometimes, Sculptra or Fat transfer can be used instead of Bellafill but this depends on the examination of the acne scars. Find a plastic surgeon who offers all of the above and talk to him or her about the best treatment plan for you.
Acne Scarring - Is This a Life long Sentence?
Acne scars can destroy your self esteem. No matter how often you hear, "It's not really that bad," you know exactly how bad it is to YOU.
Just as it took a long time to accumulate the scars, it can take considerable time to improve them. The term "improve" is used on purpose, because we've yet to have a treatment or blend of treatments that can erase all scars.
Scar treatment choices depend on a number of factors:
- Your skin type/color - genetic background opens or closes different treatment choice doors. Darker skins tend to have increased pigment after aggressive treatments, so energy levels and treatment levels have to be sometimes be turned down.
- Scar depth - very deep scars may require subcision, which means cutting the scar attachment to the deeper layer of tissue (this is done with a special needle).
- Scar profile - icepick scars will require a different procedure than rolling scars.
- Scar age - earlier scars tend to improve more quickly and at a greater level. Younger skin responds more quickly too as collagen production is at a higher level in younger patients.
- Scar color - red "scars", if flat, may only require a vascular laser. But they may also signal a depressed scar that is still in the process of developing.
- Gender - males have thicker skin, necessitating more aggressive treatment levels.
- Affordability - acne scar treatment is typically categorized as cosmetic and is not covered by insurance, making the cost factor an important consideration.
- Social downtime tolerance - aggressive treatments normally get the most results, but some patients can't or won't incorporate a week's worth of downtime for high intensity treatments. And the need for multiple treatments (and the associated downtime) is a given.
In the end, the best treatment course is highly individualized and, more often than not, will include several different treatment types. We wish we had that magic bullet that could erase the scars and the memories that go along with them. But for now, we use the most effective tools we can, to get the best results we can, as affordably as we can.
In today's dermatology office you will see a wide array of treatment options from simple micro needling all the way to carbon dioxide lasers. The higher the position on the technology ladder, the more costly the treatments, since laser and other fractional systems can fall into the $100K and above cost range.
Micro needling is making a comeback and is less risky for darker skins. Radio frequency added to micro needling improves collagen production levels and is increasingly popular with patients and doctors alike. Still, some of the most aggressive lasers provide the most smoothing potential, but they also include higher risk for post treatment pigmentation and require more recovery downtime.
Anyone who has active acne needs to get medical attention to control acne. If you stop the process of the acne, you stop the skin destruction it can cause.
How to get rid of acne scars
Following this laser technique, temporary or permanent injectable fillers can be used to improve the appearance of depressed acne scars. Other techniques such as excision, subcision, and skincare can also be used to improve appearance of the scars.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.