Scars which form in your skin after severe breakouts of acne can be very distressing. Controlling breakouts does minimize and prevent acne scarring. After a pimple, the actual skin inflammation leads to breakdown of the layers of skin and causes the dimpling that is part of atrophic scaring. Hypertrophic scarring (thickening) is possible too. We don’t completely understand why some people will get severe scars. It’s not known if hormone imbalances just trigger the inciting infectious process that causes a pimple, or if hormones contribute to the disruption of collagen that can exaggerate scaring after acne.
Scars come in many different sizes and shapes and some also with fairly dramatic names like “ ice pick scars.” The appearance of each scar is affected by how attached to the surrounding tissue. Hypertrophic scars are not keloids. Keloids build up thickness that surrounds the initial scar, and extends beyond it. Hypertrophic scars are thick, but they don’t extend beyond the actual cut, incision or skin injury site.
Although a variety of therapies may reduce the prominence of acne scars, no therapy is guaranteed removes acne scars completely. Those individuals with continuing outbreaks will need repeat treatments. The best approaches to achieve the best cosmetic results involve using a variety of treatments. An experienced aesthetician can help you judge the types of acne scarring, and work within your budget and preference to design an effective program. Very deep scars are not going to respond to very superficial treatments. So accurate determination of skin health is important.
Skin therapy can help improve the look of acne scaring by normalizing the color of the scar compared to your skin color. The color of a scar can contribute to the look and be part of which treatment is selected. Scarring and skin pigment changes are not the same thing. Skin color changes after acne, called post-inflammatory changes, slowly improve over time, but may also require treatment.
Here are some things that will affect healing: location of scar, stretchiness of the scar, how much the scar sticks to underlying tissue, nerve sensitivity in the scar area, overall health, age of the scar, your skin color (or type of skin), what treatments you have had before, and in some cases the use of medications.
Scars can be treated individually, but general scaring on the face from acne is best treated by treating the whole face. Here are some options and why they will work
- Get on treatments that will minimize future outbreaks and that will lighten any pigment.
- Get treated with a collagen remodeling procedure. Ablative lasers work the best, but will have the most downtime. This can be done with CO2 or with erbium lasers. The healing can be up to 2-4 weeks to fully heal, and it is so aggressive you wouldn’t want to repeat for about 6 months in most cases. Careful care after the treatment to be gentle to the areas of treatment are required to prevent infections, secondary scaring or poor healing have to be followed. Initial treatment typically causes pinpoint bleeding. You may get a viral outbreak so most physicians recommend preventative therapy to prevent this. Itching, dry, tense, or scabbing skin can all be a temporary side effect of the treatment.
- Address specific deep areas: fillers, non-ablative lasers performed in a series over time. Fractional procedures have less downtime, but will sometimes require repeat visits. Fillers used may include Juviderm, Restylane, or Bellafill.
- Photofacial intense pulsed light IPL treatments can help the redness some people get in their acne scars. IPL can also address texture of the skin.
- Non-ablative lasers, recovery time only 1-3 days, but will probably require 3-5 treatments at least. These can be done 3-4 weeks apart. Be wary of any sun exposure when getting laser treatments. Face can be puffy or red for a few days.
- Chemical peels can be performed with a variety of compounds, go to different depths and have a variety of healing times as well. Superficial peels are only the dermis, medium peels go to the papillary dermis, and deeper peels go to the mid dermis. They injure skin and trigger a healing response. Peels, like lasers, can trigger post treatment pigment changes, infections or their own scars. Rarely systemic effects from chemical peels can occur.
- Microneedling with or without radiofrequency. Scars can get 40-75% improvement with a treatment sequence. It can cause temporary reddening of the skin that resolves.
- Dermabrasion, essentially using tools to remove in a sandpaper way the scar area. Experienced providers can be very adept at using these tools, but poor technique can worsen the scarring. Milia can form after any cosmetic procedure, but a bit more common after dermabrasions. This can be done with what is termed a microdermabrasion which usually uses crystals and suction to produce the effects. It only works for very superficial acne scars.
- Punch excision of a specific scar can be done, but has the risk of creating other scars. It is possible to graft over the area with other skin, but most often this new skin won’t match and the overall appearance may still not be to your liking.
- Autologous platelet treatments both can heal acne scaring when on their own and make other therapies, including laser therapies heal faster on their own.
- Hypertrophic scars may require steroid injections to help soften them.
- Silicone gel sheets have been specially designed to help with scaring from acne and could be tried.