When is Acne Surgery the Best Solution to Treat Acne?

I have tried almost everything to get rid of my severe acne, but nothing seems to work in the long-term, so I am starting to think I need to consider a more drastic solution. When is surgery an appropriate and effective acne treatment?

Doctor Answers 38

Acne Surgery

Thank you for your question. The last solution to treat acne is Accutane, a form of Vitamin A. Accutane is used to treat severe nodular acne. It is usually recommended after traditional therapy has failed. I would recommend consulting a Board Certified Dermatologist for safest and best treatment option. I hope this helps.

Ice pick scars, bridging scars, tethered scars

Surgery is a great treatment for the following scars-
1. Ice pick scars- treatment with punch excision and a suture
2. Depressed scars- punch elevation and dressings
3. Bridging scars, - excision with sutures
4. Tethered or anchored scars- subscion, repeated 2-3 times

Always pick a treatment based upon your scar type. Laser is not the only answer, surgery, TCA CROSS and RF as well as lasers all play a role in acne scar management. 

Dr Davin Lim
Laser Dermatologist

Davin Lim, MBBS, FACD
Brisbane Dermatologist
5.0 out of 5 stars 43 reviews

Effective acne treatment

One should work with an experienced board-certified dermatologist to review comprehensive approach to treat active acne, prevent acne scarring and to treat existing acne scarring. Acne is a multifactorial skin condition, e.g. genetic predisposition, hormonal trigger, stress, thus requiring a multi-pronged approach. There are topical and oral prescription medications available to minimize cystic acne lesions, suppress hormonal trigger, and achieve more even tone. Scar revision may be considered with combination of punch excision of ice-pick scars followed by Fractional CO2 laser resurfacing once the acne is relatively quiescent

William Ting, MD
Bay Area Dermatologic Surgeon
5.0 out of 5 stars 11 reviews

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Acne scar Surgery - Best time


Treatments like intralesional steroid injections to cystic acne do help in treating severe and resistant cysts. But if there is a lot of active acne, then scar surgery is best held off for when there is less activity.
We do combine treating scars with treating acne - newer evidence suggests combining treatments like scar revision, peels, and lasers for acne scars with isotretinoin,  and there has been no adverse effects like keloids or hypertrophic scars in our experience, which is in agreement with current publications. And this is in skin types IV/ V/ VI, in South India. 
Good luck. 

Acne scars - a multimodal approach

Thank you for your question.  I find that multimodal approach to acne scar treatment is much more effective than any single treatment modality.  The multimodal approach usually encompasses the following:
1) fractional laser resurfacing - CO2 is ideal for lighter skin types who can tolerate some downtime and usually requires one treatment.  Radio frequency treatments are better for darker skin types or those who don't want as much downtime.  They usually require several treatments.
2) Subcision techniques to break the tethering between the base of the scar and the underlying tissue.  This is usually coupled with dermal fillers to help occupy the newly released space.  Treatments are often repeated yearly, with improvements seen with each treatment as the untethered skin starts to remember it's less tethered state
3) Sculptra - is a specialized filler that builds collagen and when injected superficially, has also been found to help remodel the skin under the the acne scars
4) Ulthera - is a non-invasive approach to tightening the skin via collagen formation to help tighten the appearance of acne scars
5) Profound - is a minimally invasive radio frequency microneedling approach that stimulates Elastin, collagen and hyaluronic acid formation in the skin.  It also shows promise in helping with acne scars, but does require more study.
6) maintenance therapy with chemical peels, microdermabrasion and skincare are also important measures.  
7) keeping good control of any active acne is also important to help maintain a healthy looking skin and mitigate against future scar formation.

A consultation with a board certified plastic surgeon or dermatologist who has these multimodal approaches will be a great way to customize an approach for you.

Solutions for Acne

There are many treatments and solution for acne.  The cause of acne may be hormonal, infectious, or genetic.  The range of treatments vary from acne surgery to chemical peels, and antibiotics and retinoids to Accutane.  For the best treatment a thorough work-up is needed to review the causes and determine the most appropriate treatment.  Please find a board certified dermatologist for the best results.

Acne Scarring Treatments

Presently, there are no topical home remedies to remove acne scarring. Acne scarring can be improved by laser resurfacing , surgical dermabrasion and fractional radio-frequency treatments. It is recommended to be evaluated by a plastic surgeon to discuss your options.

Craig Mezrow, MS, MD, FACS
Philadelphia Plastic Surgeon
5.0 out of 5 stars 14 reviews

Acne Surgery

For the most persistent and problematic acne you may require acne removal surgery. Acne removal surgery can be many different things. Acne laser surgery is able to address acne at its root and correct overactive sebaceous glands which are creating a breeding ground for acne on your skin. Acne scar removal surgery uses lasers to resurface the skin to help eliminate the affects of acne scarring. Acne removal surgery can also mean the surgical draining and removing of the most persistent and painful nodules. It is important that you seek out a top board-certified dermatologist in your area to determine the best course of action regarding your acne. 

Daniel Shapiro, MD
Scottsdale Plastic Surgeon
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Acne Surgery Just One Part of Treating Acne

Acne surgery alone is not the best solution to treat acne, rather it is one option of many.  Acne surgery isn't even appropriate for all types of acne. Acne typically necessitates medical treatments such as over-the-counter and presciption topical medicines and/or prescription oral medications.  Acne surgery is typically considered "adjuvant" therapy and will be more effective if used in addition with a medical acne regimen. There are also office-based treatments such as Isolaz, Silkpeel Dermalinfusion or chemical peeling that can be helpful in treating acne. Everybody's skin is different and every acne case is different requiring a different regimen. I recommend you consult with a board-certified dermatologist. 

Acne Surgery is just one piece of the puzzle

Acne is a condition where many different treatments can be used.  Topical and oral antibiotics, retinoid creams, benzoyl peroxide, salicylic and glycolic acids, birth control pills, and laser treatments may be utilized in a treatment regimen.  Accutane is usually reserved for more severe cystic acne that doesn't respond to the above treatments.  Acne surgery is a good option as part of the regimen for open and closed blackheads, but it is not used as a single treatment.  A board certified dermatologist can tailor a good regimen for your specific acne type. 

Donna Bilu Martin, MD
Aventura Dermatologist
5.0 out of 5 stars 1 review

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.