Treatment of Acne Scarring

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Acne scars are of great cosmetic 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 marked improvement in the appearance of most acne scars, whether they appear on the face or on the body.

There are many different types of acne scars which accounts for the wide range of variability in their appearance.  Some are sharply dimpled “pock marks”, others are larger and flatter with varying degrees of depression, still others have a “rolling” appearance, and some are firm and elevated while still others are red and angry looking.  Therefore, it is not surprising that there is no single treatment or procedure that will give optimal improvement of acne scars.  Rather, a combination of surgical, laser, and sometimes medical procedures must be employed to achieve ideal outcomes.

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 frequently are found on the cheeks and temples.  Excision 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.  At times, large numbers of ice pick scars can be removed at one surgical setting.  Typically only 1-2 stitches are required at each surgical site.  These stitches stay in place for approximately 1 week.  Some patients who have larger areas of depressed scarring will require either excision of the entire area with repair of the defect that is subsequently created 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 excised, or from donor sites such as the area behind the ear.

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 in which a tiny blade is used 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.