Category : Dermatology
Scars form when the skin is damaged. With acne inflammation, different types of blood cells and collagen rush to the point where injury may repair the skin. But they can’t always return the skin back to normal, especially when severe acne doesn’t give the skin time to heal before it breaks out again.
Scars form because collagen fills in damaged skin areas in a column pattern that mimics the wound. The collagen binds the skin, but it also pulls the skin down and contracts it making it a different texture from surrounding skin.
In scar treatments, we break up the collagen. Then, as it re-grows, it comes back more randomly and the web of collagen produces smoother skin. If you’re living with scars, we have two primary treatments for breaking up the collagen and rejuvenating your skin.
Types of Acne Scars
When you’re ready to treat your acne scars, your first step is identifying what type you have. You may have one specific scar that bothers you or a combination of multiple types of scarring.
- Depressed – Goes down into the skin
- Raised – Rises from the skin
- Discolored – Lighter, darker, or redder than your skin tone
Depressed Scars
Also called “pitted” or indented acne scars, they go down into the skin. Some are rather shallow; others extend to the lower layers of the skin. These scars usually appear on the cheeks and forehead and most likely came from inflammatory acne. Here are the three specific kinds:
Rolling Scars
Rolling scars are broad depressions with sloping edges. They can be shallow or deep but most likely came from long-term inflammatory acne. As the skin ages, it loses elasticity and fullness, making rolling scars more pronounced.
Because the edges are rolling, these scars respond great to treatment.
Boxcar scars
These scars also left broad depressions in the skin, but the edges of the scar are sharply defined. Since the edges are steeper and more distinct from the surrounding skin, they’re more difficult to treat.
Ice Pick Scars
These deep, narrow scars often look like an open, enlarged pore, or an ice-pick wound. As the deepest depressed scar, it’s also the most difficult to treat.
Depressed scars respond best to more aggressive treatments. Fractional laser treatments, Dermarollers, Subscicion and Fillers improve the skin’s texture after acne. However, the depth of the scar and steepness of the edges often determine how effective the treatment will be.
Raised Scars
If you have a raised scar, you likely had a cyst there before. As the cystic acne healed, too much scar tissue formed in its place. Now it’s a bulge of thick, rubbery scar tissue (called a keloid or hypertrophic scar) that protrudes from the skin.
These scars aren’t as common as other types, but if you have them, they’re likely on your chest, back, or jawline — where you had cystic acne.
Raised scars respond well to treatment. They respond well to intralesional steroid therapy or topical creams.
Discoloration
If you’ve had acne, you likely have skin discoloration. Discoloration isn’t technically a scar but is the most common side effect of acne. Whether brown, red, or white, the pigment in these areas isn’t the same as the rest of your skin tone. Often, the discoloration fades with time. But sometimes, the change in color becomes permanent.
There are three categories of discoloration — and treatment options for each!
If you have a brown discoloration, you’re dealing with hyper-pigmentation. The acne damaged the skin cells, and the cells that produce melanin (melanocytes) either multiplied or overproduced melanin in an effort to recover. Consequently, you ended up with a freckle-like spot that won’t go away.
There are several options for treating dark spots. We use chemical peels or topical creams that reduce melanin production (so the pigment decreases) and increase cell turnover (so you can slough off the discolored skin).
Hypo-pigmentation is characterized by the light spots that result from a lack of melanin. With this type of skin damage, melanocytes are depleted from the injured area or lose their ability to produce melanin. This occurs when healthy skin has been replaced with scar tissue. Because scar tissue has a light pink color, it’s more noticeable on people with darker skin tones.
Few treatments completely erase hypo-pigmentation, but chemical peels and laser resurfacing can be helpful in creating a more balanced skin tone.
Erythema is a permanent redness that comes from damaged skin cells. Small capillaries near the surface of the skin become permanently dilated, resulting in a red spot. It’s common in acne patients and most visible in lighter skin.
For treatment, we can prescribe a topical medication or lasers to reduce the redness.
Schedule an Acne Scar Treatment Today
If you’re ready to start the process of removing your scars, rest assured, you’re in good hands.
We start with a consultation. A Dermatologist will examine your skin to determine your skin type and the severity of your scarring. Then they’ll decide how many treatments you’ll need. Typically, dark skin requires more treatments. Because dark skin is more prone to produce pigment, we reduce the amount of energy for each treatment. That way, you’ll avoid dark pigmented areas after your treatment.
You’ll also learn how to prepare for your treatment. We will suggest you medications to apply before your procedure to prime your skin and avoid pigmentation. You’ll also receive information on pain medication and the downtime you’ll need as you recover. If you decide to take time off work, you can schedule your procedures before a weekend or take a few days off.
After your treatment, have your sunscreen ready. You’ll need to apply it heavily in the weeks following your procedure to avoid over-pigmentation.
Every acne scar treatment is adjusted depending on the person’s skin tone and how they react to the particular procedure.