Getting Rid of Acne Scars? There Are More Options Other Than Lasers

A lot of patients are surprised to still see the appearance of their acne scars on their faces despite several laser treatments. I’ve seen many a patient, out of frustration most usually, hop onto different aesthetic treatments in vain hope of solving their acne scars, usually without getting proper consultation on what procedure works best.

You might have found your way to this article in the hope of learning about the right treatments for your unsightly acne scars after undergoing laser treatments that did little to eliminate your acne scars. You are definitely in the right place!

As a doctor with multiple years of experience dealing with acne scar cases, let me first say this: there are more options to get rid of your acne scars other than lasers!

What Are Acne Scars?

The skin is a very delicate and amazing organ. When wounded, it naturally responds to the injury by regenerating fibrous tissues to heal the damaged part of the skin. However, these tissues are nowhere similar to the skin’s original state. The tissues’ formation is not organized and the collagen fibres are in disarray under the epidermis, making the newly formed skin strikingly stand out from the normal skin.

What Causes Acne Scars?

acne formation

The most common cause of acne scars is cystic acne. The damage of this type of acne goes deeper into the layers of the skin. Another cause of acne scars, especially for mild to moderate acne, is pricking. Normally, pimples heal on their own, although this may take awhile. However, some patients become impatient and begin to prod on their inflamed skin. This action actually causes more harm and exposes the skin to possible infections. When the skin is wounded due to the pricking, expect to see scars to develop as it heals.

What Are the Kinds of Acne Scars?

There are 3 main kinds of acne scars:

  1. Atrophic Scars – These scars heal just beneath the normal layer of the skin. Because of the skin’s inability to regularly stimulate tissue production, atrophic scars appear to be indented to the skin as it heals. Atrophic scars are further subdivided into 7 kinds: boxcar, bump (raised papule), deep pit, deep rolling scar, enlarged pore, shallow pit, and shallow rolling (saucer).
  2. Hypertrophic Scars – This kind of scar leaves the wounded skin raised and thick as it heals. The raised scar covers the entire area of the injured skin only.
  3. Keloid Scars – Keloid scars are similar to hypertrophic scars. The only difference between the compositions of the scars is that the keloid scars go beyond the original boundaries of the wound.

Does the Depth of the Scars Differ From Each Kind?

Yes, the depth of the scars differs from one to another. When treating acne scars, the depth of the scars is one of the considerations that doctors look into to be able to customize an effective treatment plan.

How deep a scar can go can be known by making different kinds of facial movements, like talking or smiling. As the muscle of the skin stretches and contracts, the deepness of the scar becomes all the more noticeable. Note that scars can go further down the layers of the skin. These are the types of scars that take a longer time to treat.

What Are the Different Types of Treatments Available for Acne Scars?

Below is a table that lists several procedures available for treating a wide area of acne scars.

TYPE OF TREATMENT

DESCRIPTION

RESULTS AND DOWNTIME

Lasers

There are several kinds of lasers available. Note that there is not a single one that can treat all of the types of acne scars that may be present on your skin.

For example, Fractional Ablative Laser (Fractional CO2, Erbium lasers) are good for skin resurfacing. However, this type of laser only reaches the epidermis and dermis layers of the skin.

Recovery for Fractional CO2/Erbium laser treatment may take up to 4 days. There is also a risk of getting hyperpigmentation after a treatment.

Microneedling

Radio-frequency

The most recommended method for this treatment is the insulated microneedling fractional radiofrequency. An example of which is INFINI.

With regular microneedling radiofrequency, the entire needle that penetrates through the skin is charged with radiofrequency.  While with insulated microneedling fractional radiofrequency, only the tip of the needle is charged with RF.

Insulated microneedling fractional radiofrequency is the safest among all microneedling radiofrequency procedures as this procedure leaves less damage to the upper layers of the dermis. Because there is no damage done to the top layer of the skin, recovery is quicker as well. Downtime for this type of treatment is normally 1 to 2 days.

Insulated microneedling fractional radiofrequency poses a minimal risk of developing side effects such as skin discolouration or post-inflammatory hyperpigmentation. 

Subcision

When used for treatments, subcision is usually paired with fillers. Subcision makes use of a needle that is injected to cut the fibrous tissue beneath an indented scar. Fillers (such as Rejuran) is then injected and helps in healing the skin underneath. The skin then regenerates and is reformed.

The combination of subcision and filler is best for deep acne scars. Likewise, this procedure can accurately determine the depth of an acne scar.

Patients can expect to see results right after a session. Results are also permanent. In addition, subcision with the use of a blunt-micro-cannula offers the least amount of downtime, risk of bruising, and skin inflammations.

Below is a table that lists several procedures available for treating ice-pick or individual scars.

TYPE OF TREATMENT

DESCRIPTION

RESULTS AND DOWNTIME

Punch Excision

This procedure is best to treat scars that cannot be addressed by other procedures mentioned in the table above.

Punch Excision is a minimally invasive procedure that uses a small cutter, similar to a cookie cutter, which works to punch the epidermis and excise the scar. Once the scar is removed, the hole will either be sutured close immediately or filled in with a small piece of skin extracted from another part of your body.

Punch excision may take a bit of time for recovery. Normally, patients who have undergone this procedure are advised to wear a dressing over the areas that are recovering.

Punch excision may leave additional scarring and also hyperpigmentation.

TCA Cross

Trichloroacetic Acid Chemical Reconstruction of Skin Scars or TCA Cross is the most recommended procedure to eliminate ice pick and boxcar scars. It works like a chemical peel that is applied deep into the pit of the scars in order to regenerate new skin.

After a TCA Cross session, patients can expect to see improvements within 3 to 4 weeks. This is the approximate time when collagen stimulation is activated and regenerates new skin.

Mild redness can appear on the treated areas of the skin.

What Is the Best Acne Treatment for My Skin Condition?

No two persons have exactly the same acne scarring condition. Hence, I always recommend patients to have a thorough consultation with the doctor. In this way, a doctor can properly assess the treatment needs of the skin.

Treatments can be customized according to the present acne scars that need improvement. What I have observed in my years of practice is the importance of having the right treatment administered to the patient. I have adopted what we call the 360-degree approach in treating my patients with generalised acne scarring. In this approach, I use several procedures in one treatment plan. The maximum number of sessions that completes a treatment plan is 8.

Not all clinics offer this type of treatment plan as it is such a tedious approach that requires time, several resources especially with equipment, and, for doctors, expertise in executing such an approach.

Here is an example of a treatment plan for one of my patients.

My patient is a female executive with a combination of different kinds of acne scarring: boxcar, ice pick, and rolling scars. Because of her work that requires being exposed under the heat of the sun for an extensive number of hours, she requested for a treatment that would be safe and would not further damage her skin. She also could only spare 3 days for recovery time due to having already planned an overseas trip in the following week.

This was the treatment plan I prescribed for her:

KIND OF SCAR

TYPE OF TREATMENT

NUMBER OF SESSIONS

Boxcar Scars

Sublative

2 sessions

Fractional CO2

2 sessions

Ice Pick Scars

TCA Peel

2-3 sessions

Subcision + Filler

3 sessions

Rolling Scars

PicoPlus Triple Depth

2 sessions

Infini RF

3 Sessions

How Much Improvement Can Be Expected For A Complete Acne Scar Removal Treatment?

improvement after acne scar removal treatment

Patients can expect an 80 to 90% success rate with the program mentioned above. The duration of one full treatment may be from 3 months minimum to 12 months max. Of course, bear in mind that the time spent for the treatments is largely dependent on the types of acne scarring that are needed to be addressed.

Final Advice

Remember that there are a variety of ways to navigate your acne scar removal process. When consulting with your doctor, be sure to have these three things included in your treatment plan:

  1. Regenerative Treatments – these treatments have quicker downtime and can improve acne scars remarkably by 50%.
  2. Laser Treatments – Although not the only “answer” to removing acne scars, lasers still play a vital role in any acne scarring removal treatment.
  3. Subcision + Filler – This treatment is like hitting 2 birds with 1 stone. It does two things at once: it breaks down scars and at the same time instigates the recovery and healing of the skin. Results are noticeable even right after a procedure.

I hope this article was able to help you understand the different ways of being able to banish acne scars from your skin. I wish you luck on your journey to smooth and glowing skin!