Acne Scarring

• Rolling scars are depressed scars with sloped edges that merge with normal-appearing skin. They can be circular or linear. They can contain bands of scar tissue that cause the skin to adhere to the structures under the skin. They are the most common type of acne scarring.
• Icepick scars are sharp, pointy scars that deeply penetrate the skin. They are more commonly seen on the cheeks. Treatment includes punch excision that removes the scar. This is a minor surgical procedure. The wound is sutured closed. There will be a tiny scar that can fade on its own. The procedure can be followed by a chemical peel or laser resurfacing for improved results when needed or desired.
• Boxcar scars are wide, shallow depressions with sharply defined edges that look like cutouts. Shallow boxcar scars can often be addressed with resurfacing, whereas deeper ones are treated aggressively.
• Hypertrophic scars are raised and firm and remain within the borders of the original acne. They are most effectively treated with injections, surgery, laser resurfacing, and cryosurgery.

Treatment options for acne scaring depend on the type of scar and include the following options.

• Acne scar surgery involves a minor procedure to make the scar less noticeable by lifting the scar or breaking up the scar tissue. Subcision is when the scar tissue is broken up to induce new collagen formation to fill the depressed scars. It may be combined with laser treatments for improved results. This approach is best for a few depressed or raised scars. When used for raised scars, the surgery is followed by injections of corticosteroids.
• Skin resurfacing, with lasers, chemical peels, and dermabrasion, is best for patients with widespread shallow depressed scars and raised scars. Resurfacing will make these scars less apparent.
• Laser skin resurfacing: uses fractional pulses of laser light to break down the scar tissue and generate healthy new skin to improve the scar’s tone and texture. It works on all types of scars: raised, depressed, and pinpoint scars. Typically, treatments depend on the degree of correction needed.
• Fractional radiofrequency microneedling has been shown to be clinically effective in improving acne scars and inducing collagen formation and tissue remodeling with minimal downtime.
• Intense pulsed light (IPL) is a treatment using short bursts of intense light to improve the appearance of hypertrophic scars, reducing height, redness, and hardness of the acne scars.
• Dermal fillers can be injected into depressed scars using a collagen-stimulating hyaluronic acid filler or your own fat. Some fillers are permanent, and some are only temporary.
• Radiofrequency skin tighteningheats the skin to stimulate new collagen formation to remodel scars, making depressed scars less noticeable. It is best for mild to moderate scarring.
• Microneedling causes the skin to produce collagen to fill in depressed scars. Microneedling has a lower risk of post-inflammatory hyperpigmentation.
• Retinoid creams (Vitamin A based) can stimulate collagen formation and improve the appearance of acne scars.
• Chemical peelsRemoves the damaged outer skin layers, leading to improvement in the appearance of acne scars. There are multiple types of chemical peels, ranging from mild to strong formula strengths. Your type of scars and your treatment goals will help your Bliss Dermatology provider design a plan customized for you.

1. https://www.aad.org/media/stats-numbers
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646434/