There is no single method or tool available that treats all types of acne scars. Treating acne scars requires the right combination of multiple different tools and techniques. Also, active acne needs to be under control before treating the scars.The first step in treating acne scars is to identify what type of scars are present. Scars can be classified as ice pick (deep, narrow indentations), box car (punched out indentations), and rolling (broad depressions without sharp edges).
Other marks left behind after acne include lingering red spots and darker areas of discoloration. While these are not truly scars, many patients refer to them as acne scars.
We treat each of these scars and marks a little differently, and, sometimes, we can use more than one technique to treat the same type of scar.
Ice Pick and Boxcar Scars
For these scars, I use three main techniques. One is fractional CO2 laser resurfacing using the Deep FX, another is a chemical peeling technique called CROSS, and the last is surgical removal.
Fractional resurfacing with a CO2 laser can produce about 50 – 60% overall improvement of moderate to severe acne scars after 2 – 3 treatments. Since this treatment works by remodeling collagen, you really start to see results 3 months after treatment.
CROSS stands for chemical restructuring of skin scars and is a method of applying high concentrations of TCA (trichloracetic acid) directly into the scar. Studies have shown about a 65% improvement after 4 treatments.
Isolated scars not responsive to the above treatments, can simply be cut out using a punch tool (a very small round cutting instrument) and sewn together carefully.
Rolling scars are usually distensible, meaning they can be stretched flat. For these types of scars, it usually best to fill them. I like to use Radiesse because it lasts for over a year, but sometimes Restylane or Juvederm is a better choice.
If ice pick and boxcar scars can be distended, they can be filled too.
Lingering redness that remains long after the acne is gone is usually best treated using a laser. I use the V-Beam since it is the gold standard in treating redness. Other lasers can be used, too.
Dark spots left behind after acne tend to occur most commonly in darker skin tones. These are not truly scars. The foundation of treatment for these are bleaching creams. Hydroquinone is the fundamental bleaching agent. It is available in a 2% formulation without a prescription. I often prescribe higher concentrations and combine it with other bleaching products.
Protecting your skin from the sun is also essential. Wear an SPF 30+ sunscreen every single day that blocks UVA and UVB. Avoid direct exposure to the sun as much as possible. To get your vitamin D, take supplements.
I find chemical peels helpful as well. A light peel every few weeks speeds up the removal of the dark spots.