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In general, there are three types of acne
scars. It is important to distinguish between these three types of scars as the
treatment for each varies considerably.
 | Ice-pick scars: typically
deep pits that can occur anywhere on the face. |
| Shallow, depressed scars:
typically slightly depressed areas, which can often look like shallow
chickenpox scars |
| Deeper, depressed scars:
deeper depressions which occurs most commonly on the cheeks |
For many patients, there is no one procedure
that will accomplish all of one's goals. Therefore, is often best to use a
combined approach utilizing two or more different procedures to achieve an
optimal result. Occasionally these procedures can be performed at the same time,
although often these procedures are performed several weeks apart. Below is a
list of commonly performed procedures, their limitations and benefits.
Treatment modalities
commonly used for shallow, depressed scars
| Superficial Chemical Peel (glycolic acid, salicylic acid peels, and
15-20% TCA): these superficial peels
are often used to improve acne and/or staining of the skin (dark spots). In
general, these peels affect mainly the epidermis (the top layer of skin).
Unfortunately, the superficial peels offer little improvement with acne scars,
where the damage is in deeper layers of the skin--the dermis. In general,
these peels offer little or no improvement of ice-pick scars, and minimal
improvement of shallow depressed scars. One of the benefits of these
superficial peels is that there is minimal recovery needed. Most patients will
experience some peeling, redness, and/or flaking of the skin for up to week.
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| Medium-Depth Chemical Peel (70% glycolic acid or 35%+TCA peels):
these peels are often used to
improve wrinkles or superficial scars, including acne scars. Depending upon
the depth of peel achieved, recovery may be several days to several weeks or
longer. This type of peel works best for shallow depressed scars, with minimal
affect on ice-pick scars. |
| Laser-Peel (carbon
dioxide or Erbium:YAG): unlike chemical peels which rely on acids to
damage the skin, the laser-peel utilizes laser energy to precisely peel away
layers of skin. This type of peel works best for depressed scars. Like the
medium-depth chemical peel, recovery typically takes several weeks or longer.
Additionally, redness of the treated area may last for several months. The
final result may not be fully appreciated for one year or longer. |
| Dermabrasion: with this
modality, layers of skin are sanded away. In general, dermabrasion typically
works best for shallow depressed scars, with only modest improvement, if any,
on ice-pick scars. The recovery or dermabrasion typically is one or more
weeks, although redness of the skin can persist for several months
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| Collagen Injections:
collagen, which may be from a cow or a human, is injected directly into the
scar. One of the benefits of this procedure is that little or no recovery is
needed. Unfortunately, results are not permanent, and touch-up
procedures are required every three to nine months to maintain optimal
results. |
| Restylane™ Injections: This
product is injected directly into the scar. There is little to no recovery in
most cases. Unfortunately, results are not permanent. Results typically last
longer than collagen injections. |
| Fraxel™:
This newer type of laser ablates microscopic spots of tissue. Unlike tradition
Laser-peeling, several treatment sessions are needed and mild-moderate
improvement can be achieved. The advantage of this modality over Laser-Peels
is that healing is fast (days). |
Treatment modalities commonly used for
deeper, depressed scars
| Fat Transplantation: in
this procedure, fat is taken from one area of the body (usually the hip) and
mesh transplanted beneath the depressed scar to elevate it. Occasionally,
multiple procedures may be necessary to achieve optimal results. Results may
or may not be permanent. Patients are usually required to abstain from any
exertional activity for one week or longer after the procedure. Additionally,
some mild swelling may result in the procedure, although typically resolve
within several days. |
| Collagen Injections:
collagen, which may be from a cow or a human, is injected directly into the
scar. One of the benefits of this procedure is that little or no recovery is
needed. Unfortunately, results are not permanent, and touch-up
procedures are required every three to nine months to maintain optimal
results. |
| Collagen Injections:
collagen, which may be from a cow or a human, is injected directly into the
scar. One of the benefits of this procedure is that little or no recovery is
needed. Unfortunately, results are not permanent, and touch-up
procedures are required every three to nine months to maintain optimal
results. |
| Gore-tex™ Implantation:
Gore-tex, which is commonly used in clothing, is made into strands, threads,
and mesh-like material. This material is placed directly beneath the depressed
scars, thus elevating them. Correction using Gore-tex may be permanent,
although the implant material can be felt under the skin. This procedure
requires little or no recovery time. |
| Excision: deeper scars
may be cut out using a scalpel and stitched together. This results in the
formation of a linear scar, which in some cases may look better than the
depressed scar. |
| Punch Grafting: with this
procedure, small depressed scars are cut out using a small "punch", which
resembles a small cookie cutter. A small piece of skin is then removed, using
a "punch", from in front of or behind the ear and transplanted to where the
scar was located. This new transplant skin is then secured in place using
special tape strips or glue. The hole from where the skin was removed from in
front of or behind-the ear is sutured using stitches. Often, several weeks
later a dermabrasion or laser-peel is performed. |
| Sculptra™:
this newer product is injected into the skin. Results can last for
1-2 years or longer. Most patients have 2-3 treatments spaced 6
weeks apart. |
Treatment modalities often used for
ice-pick scars
| Punch Grafting: with this
procedure, small depressed scars are cut out using a small "punch", which
resembles a small cookie cutter. A small piece of skin is then removed, using
a "punch", from in-front-of or behind-the ear and transplanted to where the
scar was located. This new transplant skin is then secured in place using
special tape strips or glue. The hole from where the skin was removed from
in-front-of or behind-the ear is sutured using stitches. Often, several weeks
later a dermabrasion or laser-peel is performed. |
| Excision: deeper scars,
including ice-pick scars, may be cut out using a scalpel and stitched
together. This results in the formation of a linear scar. |
| Laser-Peel (carbon
dioxide or Erbium:YAG): more recently, the laser-peel has been used for
ice-pick scars. Unfortunately, results are typically inferior to other methods
such as punch grafting or excision unless combined with excision or punch
grafting. |
| Collagen Injections:
collagen, which may be from a cow or a human, is injected directly into the
scar. One of the benefits of this procedure is that little or no recovery is
needed. Unfortunately, results are not permanent, and touch-up
procedures are required every three to nine months to maintain optimal
results. Individual results vary considerably, as some experience little or no
benefit, while others may experience moderate or significant improvement. |
Summary:
As with most cosmetic surgery, treatment options must be considered on
individual basis, as no one procedure is best for all. In many cases, one
procedure may not afford as much benefit as two or more procedures. Therefore it
is essential to evaluate each person on individual basis and devise a treatment
plan based on the patient's desires for improvement, recovery time needed, cost,
and the risks of the procedure(s).
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