As if acne isn’t frustrating enough, many acne sufferers are left with visible scars on their face, shoulders, and back after their breakouts have cleared—and these scars can even worsen with age. A number of treatments are available to help reduce their appearance, but there is no one-size-fits-all solution. Each type of acne scar requires a special approach, and a series of combination treatments are usually necessary for a satisfactory result from acne scar treatment.
The 5 types of acne scars
Most types of acne scars fall under the umbrella categories of atrophic acne scars. Atrophic scars include all indented scars: icepick, rolling, and boxcar scars. There are also raised scars that project out from the surface of the skin, which may be either keloid or hypertrophic scars. Before deciding on a treatment plan, your facial cosmetic surgeon will identify which type(s) of acne scarring you have:
- Icepick scars — Icepick scars appear narrow and deep, as though an instrument was used to make them.
- Rolling scars — Rolling acne scars appear as a generally uneven, hill-like skin texture, without isolated scars.
- Boxcar scars — Boxcar scars are somewhat shallow and wide crater-like scars that appear as indented shapes, such as squares or ovals.
- Keloid scars — Keloid scars are raised bumps on the skin, usually dark in color, that grow beyond the borders of the original skin wound or acne lesion.
- Hypertrophic scars — Hypertrophic scars are thick scars that can be flat or raised. Unlike keloid scars, these do not grow past the area where the skin was originally wounded.
Acne scar treatment options
Many patients have multiple different types of acne scars, and it is common to have multiple forms of scarring on different areas of the face or body. Still, the treatment combination that will be most effective for you depends on the type of scar present. Here are the treatment options available for improving the texture of acne scars, as well as what kinds of scars they treat:
Dermal fillers
Fillers are injected beneath the skin to raise indented, or depressed, acne scars. Commonly used fillers for acne scars include poly-L-lactic acid (PLLA) fillers, hyaluronic acid (HA) fillers, calcium hydroxyapatite fillers, and polymethyl-methacrylate (PMMA) fillers. Patients interested in using their own fat as a natural dermal filler may also seek out a “fat transfer” procedure in which harvested fat from a donor area of the body is used as a dermal filler.
Which acne scars do dermal fillers treat? Deeper atrophic scars, particularly rolling or boxcar, usually combined with collagen-inducing skin treatments
Laser skin resurfacing
Laser skin resurfacing involves passing precise wavelengths of light across the skin to trigger the body to supply new collagen to the skin, helping to remodel the skin and diminish the edges of acne scars to make them less noticeable. There are many varieties of laser, including ablative and non-ablative, fractional and not fractional, available. The more intensive lasers among these require more downtime and should be chosen carefully, but they can achieve striking results with just one treatment.
Which acne scars does laser resurfacing treat? Atrophic scars (icepick, rolling, and boxcar)
Chemical peels
Chemical peels involve application of a solution that prompts the outermost layer of skin to peel in the course of the days following treatment. This stimulates new skin growth with a more even texture and appearance.
Which acne scars do chemical peels treat? Atrophic scars (icepick, rolling, and boxcar)
Microneedling (a.k.a. Collagen induction therapy)
Microneedling involves passing a device containing many very small, hair-like needles across the skin to promote collagen production (neocollagenesis) through micro-injury, prompting the body to “heal” the treated areas and creating smoother skin. To see best results, most patients require a series of 3-6 treatments.
Newer microneedling devices may combine microneedling with radiofrequency (RF), which is delivered via the needles deep into the epidermis and dermis to promote skin contraction and remodeling of deeper scars.
Another recent innovation involves combining microneedling with platelet-rich plasma (PRP). In this treatment, the patient’s purified blood platelets are applied to the skin as part of the microneedling treatment to promote healing and enhance the treatment’s effects.
Which acne scars does it treat? Atrophic scars (icepick, rolling, and boxcar)
