Proven Solutions for Physical Acne Scars

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Depending on the type of scar that plagues your skin as well as the type of acne that caused the blemish in the first place determines how your doctor will treat the problem at hand. Since every scar and skin type is different, customization is key in attaining smooth, soft skin again. These five solutions are proven to work:

1: Fillers and Injectables

Giving temporary improvement at best, hyaluronic acid fillers physically lift the skin and fill in the depression to give a more even and smooth surface. As Beverly Hills, CA, dermatologist Karyn Grossman, MD, explains, fillers can be used to raise the base of the scar so that the “valley” of the scar is more even with the rest of the surface of the skin. Besides filling in the depression, fillers may also provide a regenerative effect to damaged collagen. “The needle used to inject the fillers kind of releases the damaged tissue to concurrently create a healing process,” notes Orlando, FL, dermatologist Kathleen Judge, MD. It’s common for your doctor to prescribe a laser treatment or subcision with fillers to give a uniform look. 

Fillers and injectables work best for isolated shallow scars on the surface or to fill out residual depressions following other modes of treatment. “If you try and fill scars that are more raised and rigid the filler can shift to the side of the scar and make it look worse,” says Dr. Grossman. Results are seen immediately but are not permanent. 

2: Subcutaneous Incision/Subcision

Just like how subcision can be used to treat cellulite, a similar technique can alleviate rolling acne scars. “We take a needle and make multiple punctures underneath the scar to loosen the scarred tissue so it’s not as depressed,” explains Mansfield, TX, dermatologist Jeannine Hoang, MD. “It is also a method of delivering a controlled injury to the dermis in hopes of stimulating new collagen growth, too.” While subcision does help, multiple treatments may be required and your doctor may suggest fractional laser treatments be performed as well to provide optimal improvement.

This solution works best for rolling scars. Results are seen after about one week. Any bruising and swelling will take about that long to subside. Additional sessions may be necessary. 

Solution 3: Punch excision

This surgical solution, which is often reserved for deep icepick and boxcar scars, involves the use of a special cookie cutter-like tool that excises the scar. Performed under anesthesia, the scar is removed and the skin is then closed up with sutures, which can leave behind a tiny scar (it can be minimized with post-treatment lasers). Some doctors choose to perform punch excision alongside skin grafting. “The procedure may cause discoloration from the surgery portion but it does improve the skin texture,” says Dr. Hoang.

It’s best for a small amount of more depressed scars; results are visible in approximately one month. No maintenance is necessary. 

Solution 4: Punch Elevation

Similar to punch excision, this technique is used to remedy scars with sharp edges. “The same instrument is used but instead of closing the scar, a small piece of skin is placed inside the hole,” explains Dr. Grossman. “The biggest problem with punch elevation is that the skin that’s placed will often elevate slightly above the rest of the skin.” 

Punch elevation works best for Boxcar scars; results are permanent and visible in a few months.

Solution 5: Fractional Laser Resurfacing (Fraxel, Fractional CO2, etc.)

Both ablative lasers, which vaporizes the outermost layer of skin and is the more intense option, and nonablative fractional lasers, which leaves the skin in tact, can help alleviate acne scars (what your doctor chooses to treat your skin with is based on the severity of your scarring, your budget and downtime). “Lasers, specifically ablative ones, remove the top layer of skin so that shallow scars are often completely removed and deeper scars are made to look more shallow,” says Denver facial plastic surgeon Michael Menachof, MD. Another plus to using lasers is that they may provide a tightening effect. “The tighter the skin, the more narrow the diameter of the scar,” he adds. “In general, scars respond well to most types of laser treatments because heat is being deposited directly into the dermis to contract the collagen,” explains Washington, DC, dermatologist Tina Alster, MD. 

This solution works best for medium to deep scars on the cheek. Initial improvement may be noticed after one week but it will take at least six months for full results to set in. Additional procedures at a later date may be necessary.

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