Acne scars are of great concern to those who are affected. Acne scarring often has profound effects on self-confidence and can even affect people’s behavior. Fortunately, by using a combination of treatment options, we are able to produce improvement in the appearance of most body and facial acne scars.
There are many different types of acne scars. Some are sharply dimpled “pock marks”, some are larger and flatter with varying degrees of depression, and others have a “rolling” appearance. Some acne scars are firm and elevated while others are red. Therefore, it is not surprising that there is no single acne scar treatment or procedure that will give optimal improvement of acne scars. A combination of surgical, laser treatments, and sometimes medical procedures can be employed to achieve ideal outcomes.
Non-Surgical Removal of Acne Scars
Some scars can be treated with injections or laser treatments. Bellafill is a filler used to counteract the effects of acne scarring by using collagen to fill depressed acne scars. Newer laser technologies such as non-ablative fractional skin resurfacing and eMatrix skin resurfacing, can also improve the appearance of scarred skin without the longer recovery times associated with traditional laser skin resurfacing.
Surgical Removal (Excision) of Acne Scars
When treating ice pick type scars, surgical excision is usually required. There are no lasers or technology-based approaches which will provide adequate correction of the scars. Ice pick scars are frequently found on the cheeks and temples. Removal of ice pick type acne scars is performed in the office with the aid of local anesthetic injections. Sedation is not required. As the scars are removed, sutures are used to repair the skin, converting the deep ice pick scar to a smoother, less depressed scar. Large numbers of ice pick scars can be removed during a single visit. Typically, only 1-2 stitches are required at each surgical site. These stitches stay in place for 1 week. Some patients who have larger areas of depressed scarring will require either removal and repair of the entire area or elevation of the depressed scars using a procedure known as dermal grafting. Dermal grafting refers to the use of one’s own tissue as a natural filler that is placed in a pocket created under the depressed area. When performing dermal grafting, tissue is obtained from ice pick type scars that are being removed or from donor sites such as the area behind the ear.
Subcision Treatment Method for Acne Scar
The scars that are not deep enough to require removal, but are too deep to be expected to respond well to laser treatment alone, are treated with a technique known as subcision. Subcision is a procedure that uses a tiny blade to release the scar from the underlying skin. This allows the depressed area to become somewhat shallower as the firm attachments holding the scar to the deeper tissues are released. Stitches are not required following subcision. Bruising and swelling may occur following both removal and subcision of acne scars.
Dr. Biesman began developing his unique approach to acne scarring some 25 years ago, well before he relocated to Nashville, TN.