About Acne Scars

Before we jump into the different acne scar treatments it’s important to understand that there are different types of acne scarring and depending on the type you are afflicted with your treatment choices will differ. It’s also important to note that most people with acne scarring have a mix of two or more different types, and when this is combined with your own unique physiology and skin type it makes selecting the right treatment that much more difficult. Take your time and learn as much as you can about scars, treatments and yourself before committing to anything.

Ice Pick Scars

Ice pick scars are named such because they are similar in shape to what you would see if you attacked a piece of wood with an ice pick: shallow or deep pitting with steep sides and jagged edges. Severe cases of ice pick scarring are often referred to as ‘depressed fibrotic scarring’. They are most commonly found on the cheeks.

Boxcar Scars

Boxcar scars are very similar in appearance to the scarring caused by chicken pox. They are oval shaped depressions with sharp edges and can very in depth from superficial to deep. These are most commonly found on the cheeks and temples.

Rolling Scars

Rolling scars are the result of tissue damage beneath the skin, and have the appearance of a rolling hillside; hence the name. Because these scars are the result of tissue damage beneath the skin, resurfacing treatments like dermabrasion and lasers will not work, instead they are usually treated with subcision (explained in more detail in the next section). These are most commonly found on the cheeks and forehead.

Hypertrophic Scars

Hypertrophic scars are small, red ‘bumps’ that appear in the damaged area, these can result from any kind of wound – not just acne, and they normally fade over time. There is a similar type of scarring called a keloid scar which take on a similar appearance but continue to grow indefinitely. Keloid scars are benign, but the fact that they never stop growing makes them a real cosmetic nuisance. These can appear anywhere on your body.

Acne.org maintains a gallery of miscellaneous acne scars submitted by their community here.

Acne Scar Treatments

Before committing to any specific method of treatment for your scarring, make sure you do a LOT of research first. Every treatment option has pros and cons, and every treatment option will improve the appearance of some people’s scars while worsening the appearance of others. These treatments can also be very expensive, which means you need to be very selective about your dermatologist – sometimes they’re in it for their patients, other times they’re in it for the money. Here are some tips to help you pick the right skin doc for you:

• When initially selecting a dermatologist, visit several different ones. Contrast what the different doctors tell you and follow it up with a little research of your own to determine which one is really the best for you. Beware of doctors that pressure you to commit on the first visit and push new and expensive procedures on you. Search for the doctors name (with quotes) in a search engine like Google and see what you find. If you’re not comfortable with any of them, move on and keep looking.
• Get each doctor to tell you very specifically what course of treatments they would prescribe for your scarring, and then get them to explain to you in plain english exactly why they are prescribing that particular course. If you think you may forget, write it down or bring along a voice recorder. Follow up their advice with your own research and if you receive opposing treatment plans, bring them up to other dermatologists and see how well they respond.
• Insist on seeing before and after pictures of their previous patients. How many of the people in the ‘before’ pictures have scarring that resembles yours? Can you contact any of these people?
• How long have they been practicing dermatologists? What treatments do they have experience prescribing and performing?

Some people who have had their acne scars successfully treated report that as they age, the scarring gradually returns. Other people who have been unable to reduce their scarring report the exact opposite effect. My point is that everyone is different. Be realistic with your expectations and above all: research, research, research! Try to get in contact with people who have successfully treated scarring that is similar to your own and learn what they did. Sometimes you can find these people through dermatologists, support groups, and online forums and communities. We’ve added some links to a few online sources at the end of this article. Now on to the treatments:

Subcision

Cost: Up to $1000 per treatment.
Procedure: Subcision is a treatment where the upper layer of skin is detached from the deeper tissue, allowing blood to flood into the opening and raise the skin in the treated areas. This is usually used to treat shallow and rolling scars and often requires multiple treatments.

Punch Treatments

Cost: $50-$150 per treatment.
Procedure 1 - Punch Replacement: This method involves physically cutting out the entire scar and replacing it with a skin graft.
Procedure 2 - Punch Excision: This method involves physically cutting out the entire scar and then stretching the surrounding skin closed around the wound and letting it heal, thus avoiding the need for a skin graft.
Procedure 3 - Punch Elevation: This method is similar to subcision; it involves cutting the scar loose from the deeper tissue below it and then letting it heal. This usually results in the treated area elevating slightly, which can diminish the appearance of certain types of scarring.

Chemical Peels

Cost: $600-$800 per treatment.
Procedure: One of many different types of acid is applied to the skin, allowed to sit for a period of time and then removed. The acid removes the top-most layer of skin. This usually results in a slightly smoother end result and is helpful for very mild scarring.

Dermabrasion

Cost: $1200-$2000 per treatment.
Procedure: Dermabrasion (not to be confused with microdermabrasion) is a process where the top-most layer of skin is removed mechanically. The skin to be treated is first numbed, and then a rotating abrasive disk is used to ‘sand’ off the top-most layer of skin. This is a painful procedure and does require some down time. Many people who have tried this approach have found that it provides only short-term results, and that the scars do grow back over time.

Laser Resurfacing

Cost: $2500+ per treatment.
Procedure: This is very similar to dermabrasion in that it involves physically removing the upper-most layer of skin to achieve a smoother effect – but instead of abrasive disks or pads, lasers are used. This is very expensive and the results appear to be very similar to those reported by people who have undergone dermabrasion – the scars can return.

Acne.org has started collecting people’s experiences with the above treatments. If you are considering any of them, you should definitely check them out here: Acne.org’s Acne scar treatments section.

Acne Scar Creams

There is certainly no shortage of creams and balms that claim to cure everything from impotence to scarring, but do they work? Most of the reports we have found say “no”, however there are always a few who claim success with these methods, so here is a list of the ones we have found that have had at least one reported success story associated with them (and we only found two!).

• Creams containing cocoa butter and vitamin E help keep your skin soft, elastic and healthy. Regular use of such creams may help scars diminish naturally over time. We would recommend combining this with an overall healthy lifestyle.
• Apply a 3x solution of medical-grade hydrofluoric acid (or a product which contains it) to the scarred area twice daily for one to two weeks. Do this ONLY under the supervision of your dermatologist because this CAN damage your skin.

Do you have a remedy or tip that can help other visitors to this page? Please share it with them using the form at the bottom of this page.

Offsite Resources

• Acne.org’s Scar Forums
• MedHelp.org’s Doctor-to-Patient Dermatology Forum
• MedHelp.org’s Patient-to-Patient Dermatology Forum
• Acne Scarring Info from AcneNet