Acne brings much that’s unwelcome — redness, pimples, whiteheads, blackheads, self-consciousness, and frustration. For many, the struggle doesn’t end when their acne is gone. Some people see scars from their breakouts long after they’ve cleared.
Is now the right time to erase them?
If your acne scars are bothering you, yes.
We now have treatment options for acne scars including dermabrasion, laser therapy, subcision treatment, excisions, skin grafting, or a combination of these procedures. If you’re bothered, self-conscious, or simply tired of your acne scars, you can take steps to make them finally disappear.
Why Acne Leaves Scars
While most patients with severe acne notice pigment changes or redness even as their acne clears, not everyone scars. Some patients, even with severe acne, see completely clear skin once their acne clears.
Others aren’t as fortunate.
We blame acne scars on two conditions — severe breakouts and genetics. If someone has scarring from acne, not only were their breakouts bad, they were also genetically prone to develop scars.
Can I Start Treating Scars Immediately?
Before we address scarring, we need to deal with the breakouts. If we see a patient who’s prone to scarring, we may recommend aggressive treatment such as isotretinoin to completely eliminate the acne as soon as possible. Our first goal is to stop the acne so we prevent the development of future scars. If we see any signs of scarring, even on patients with mild acne, we work aggressively — to eliminate any current breakouts and then erase the scars.
For patients on isotretinoin, we can begin scar treatment 3-6 months after they finish medication.
How to Treat Acne Scars with Subcision Treatment
Once acne clears, we have multiple methods for treating the scars. We select the right treatment or combination of treatments based on the type, depth, and location of the scar.
Subcision treatments are an effective way to raise scars that are lower than can be treated with a laser. Some scars are depressed to the point that we can’t laser deep enough to make a difference. Subcision treatment allows us to raise the scar before we laser the skin to an even surface. If several scars are pulled in and depressed, a simple subcision is a great place to start.
During a subcision, we first numb the area. Then, we pass a large needle under the skin to break up the scar tissue. This allows the scar to elevate. At the same time as the subcision, we can also inject a filler underneath the scar making it more likely to lift up.
Occasionally, a subcision may be all that’s necessary. But for most, subcision treatment is an adjunctive treatment to use alongside other treatments when acne scars are extremely deep. After the scar raises, we can use ablative lasers or dermabrasion to create a more even skin surface.
What Other Procedures Treat Acne Scars?
Lasers are a key component in scar treatment. In fact, most acne scar treatment plans ultimately include the use of an ablative laser. The laser works by leveling normal skin to the same level as the scar. For patients with a group of scars, the laser works to soften the transition between the normal unscarred skin to the area of the scar.
Punch grafting is another procedure we may opt to use before laser treatment or dermabrasion. If you have deep ice-pick or pinpoint scars, this procedure allows us to fill those indentations with skin.
Using an instrument called a dermal punch, we remove a plug of skin. Then, we replace it with skin from a hidden area (often we use skin from behind the ear). We secure it with single-suture and cover it with a steristrip, and the new skin heals in.
Punch grafting typically heals quickly, and is not terribly visible. Once it heals, you’ll have little raised bumps where the tissue was replaced. We then use the laser to smooth the bumps down.
We opt for dermabrasion when we need to address a specific area, not the entire face. In this procedure, we use a type of sterile rough paper to level the skin by hand.
Dermabrasion can be yet another element in the treatment process. We may punch graft the skin, use dermabrasion over that specific area, then use an ablative laser over the entire face to make it all even.
What To Expect After Treatment
For each type of treatment, patients should expect follow-up appointments that evaluate how they responded to the procedure and what additional steps are necessary.
Here’s what to expect:
Subcision: 6-week follow up with before/after photos
IPL: Repeat the procedure every 1-3 weeks
Ablative Laser: 6-week follow-up, discuss repeating the procedure at a later date
Non-ablative Laser: Repeat the procedure about once per month
How To Avoid Future Scars
Once you eliminate the scars, you certainly don’t want more. Controlling future acne is the key to preventing future scars.
Patients who have finished a course of isotretinoin may not require any additional precautions besides a healthy skin care regimen to keep their skin healthy and acne-free.
If acne starts to reoccur, consider using anti-aging products that contain retinol, tretinoin, and other vitamin A derivatives. These products help prevent the development of new acne, which in turn prevents future scarring.
Also, don’t touch your skin. Some patients develop (or worsen) their scars because they can’t stop picking at their skin. Acne excoriée results from a compulsive habit of picking at even the slightest pimple. This compulsive behavior (similar to nail biting or hair pulling) leaves patients with seemingly excavated areas of skin because of their compulsion to pop and pick at their breakouts. To a dermatologist, this condition is relatively easy to identify. If this is a problem for you, we may recommend behavior modification therapy or medication.
If you’re tired of managing your acne scars, be encouraged. You have options. Schedule an appointment with your dermatologist to discuss the treatments that best suit your skin and will be most effective in healing your specific scars.
Dr. Angelo Petropolis is a board-certified dermatologist in Sierra Vista, AZ with over 25 years of experience. He is skilled in practicing medical, surgical, pediatric, and cosmetic dermatology, and he has extensive expertise in the treatment of skin cancer, Mohs micrographic surgery, and the treatment of aging skin. In his spare time, Dr. Petropolis enjoys traveling with his wife of 42 years, Wanda, spoiling his grandchildren, and flying.