Acne Scarring

Summary

Fraxel® laser treatment has taken the treatment of acne and surgical scars to a new level, producing improvements that were not routinely achievable with previous methods of treatment.
Subcision, dermal fillers and excisional surgery still have a role to play in specific instances.

What Acne Causes Scars?

Scars are left when any injury overwhelms the skin's ability to repair itself. The skin can only reform perfectly if injuries are less than half a millimeter deep or a fraction of a millimeter wide. Injuries deeper or wider than this leave scarring.

What Are Acne Scars?

Scars are areas in the skin where the normal cellular structure has been replaced with collagen fibres. Therefore, there are no hairs or sweat glands in scars.

What Will Happen To Acne Scars?

Normal scars thicken for about eight weeks and then soften and blend in with the skin over twelve to eighteen months. Most of the improvement occurs within the first year but slow improvement does continue over the decades.

Scars that lower the the surface of the skin, such as those left by acne, chickenpox and deep wounds, become deeper and cast more obvious shadows after the late twenties and thirties. This occurs because as the skin becomes less taut and the tension within the scar can more readily distort the surface of the skin. This is most obvious on the face but occurs on the body too.

How Can Acne Scars Be Treated?

The first step is control the acne. It can be helpful to add some tretinoin cream into the treatment regime at this stage because it both helps clear the acne and promotes collagen formation which will help the acne scarring.

Once the acne has settled, Fraxel® laser treatmentbecomes the treatment of choice for depressed acne scars. It will also improve the appearance of these scars if they are flat or a bit raised. Usually five treatments with the Fraxel Re:Restore (Fraxel SR1500) will be needed with the machine used on the highest treatment settings.

The less common "rolling" acne scars require subcision.

Larger depressed scars or more complex linear scars will need to be cut out if the base of the scar looks different to that of the surrounding skin. Surgery is best done before the Fraxel treatment so that the Fraxel treatment can be used to hide the scars.

Depressed scars whose base matches the colour of the surrounding normal skin can often be raised up to the skin level with an injection of dermal filler under the scar but this will need to be repeated from time to time as the filler dissipates.

Some of the deeper "ice-pick" scars will require additional treatment with pin-point applications of 100% TCA.

The uncommon keloid acne scars can be reduced by not eliminated by a few sessions of treatment with steroid injections.