First, what causes acne scars?
Before we delve into the best treatments for acne scarring, let’s make sure we’re on the same page about acne scars. Meaning, the cause, the appearance and then the repair of the damage. Acne scars are usually the by-product of an inflamed lesion, such as a papule, pustule, or cyst. Inflamed “zits” happen when the hair follicle, or pore, becomes over-full with oil, dead skin cells, and bacteria.
Then what? The pore swells, causing a break in the follicle wall. If the rupture occurs near the skin’s surface, the “zit” heals quickly. More serious lesions arise with a deep break in the follicle wall. The infected material spills out into the lower skin layer called the dermis and destroys healthy skin tissue.
To repair the damage done to the dermis, the skin’s inflammatory defenses come to the aid of the site of damage to form new collagen fibers. Collagen is the fibrous protein that gives the skin its strength and flexibility. Unfortunately, the collagen “repair job” never looks as smooth and flawless as before the injury. That’s the acne “pock.”
Then what causes the spots?
The dark spots that remain on skin are caused by inflammation during the skin’s healing process.
When your skin is opened up (example-a pimple pop), and then closes back together, you can get abnormal tone, pigmentation and even texture.
Sometimes broken blood vessels that remain after an acne lesion fades can cause a red or purple “splotch” rather then a than a brown one. These are commonly seen in people who are more fair/light skinned.
Some acne marks are totally within your control while others are genetically pre-determined. People with deeper skin tones are more prone to develop darker marks or hyperpigmentation.
People with lighter skin tones may get more of the redness and purplish post acne markings. There are lifestyle habits that can make dark marks and scars worse.
Sun exposure can get those pigment producing melanocytes going, causing marks and scars to darken. Picking or squeezing pimples creates more inflammation which will lead to more pigment issues and scarring.
Special note to bodybuilders with active body acne and high DHT who don’t want to take a DHT oral blocker: High DHT can be lowered by certain bioidentical hormones like progesterone if you don’t want to take conventional drugs. It can also be countered topically with shampoos like ketoconozole which is a cutaneous DHT blocker.
The best treatments for acne scarring at an office:
Laser treatments are either ablative or non-ablative. Ablative lasers resurface the skin by removing outer layers. Non-ablative lasers create changes in the dermis without causing damage to the skin’s surface. Unlike ablative lasers, there is minimal to no downtime when you use non-ablative lasers but the results are not as good, quite frankly.
The Easiest ablative: Fraxel
Fraxel is the least “aggressive” ablative laser and requires at about a week of downtime. You’ll usually need 3-6 sessions to get great results.
Fraxel is the brand name of one of the first fractional lasers. The cost varies by where you live, the office, and the size of the area being treated.
A full face laser resurfacing ranges from $900 to about $1400. It can take anywhere from 30 minutes to an hour. Don’t worry, topical anesthetics are used.
More aggressive laser ablatives :
The most common ablative lasers used to treat acne scars are the carbon dioxide and erbium (YAG) lasers. These lasers burn skin tissue in a controlled manner to a specific depth.
The usual result is that “new” skin is smoother, atrophic scars are reduced in depth, and the overall look of scarring is softened.
YAG lasers are pretty much out of date. CO2 is needed for severe scarring if you can “take it.” I’ll explain.
You should expect CO2 laser skin resurfacing to cost between $2,000 and $3,000. And you’ll be oozing for 2 weeks and red for 3 months. You’ll probably need some pain medication for a week. But the results are spectacular. It’s also great for anti aging skin care but it always comes with some hefty “down time”!
Non-ablative lasers for acne scars:
Non-ablative lasers tighten the skin and stimulate new collagen formation. These lasers are most beneficial for mild acne scarring , rather than deep, pitted scars. IPL’s can treat the pigmentation “splotches” we talked about above. They do not treat the indentations but they can even up the color. However pulsed dye lasers are a form of non-ablative laser that are used to improve raised acne scars.
Punch Excision, Punch Elevation, and Punch Grafting:
Punch techniques are used to treat “ice pick” scars. A small punch tool is used to cut the scar from the skin. After the scar is excised, the skin is sutured closed. A small scar resulting from the treatment may be left, but it is much less obvious than the original one. The new scar can be faded using resurfacing techniques such as microdermabrasion or laser treatments. After a scar is excised, a skin graft can be used to fill the void. Punch grafts leave their own scars. But they are less noticeable than pitted scars and can be resurfaced very easily. By the way I’ll show you a picture of the types of acne scars being discussed.
Subcutaneous incision is used to treat rolling acne scars, as well as some depressed acne scars. “Subcision” is simple surgical procedure procedure performed under local anesthesia.
A small scalpel is inserted to run parallel to the skin’s surface. The instrument cuts the bands of tissue that tether the skin to deeper dermal structures with “messed up collagen” formations.
The skin visibly lifts once these bands have been released, smoothing the skin surface’s appearance. Yes, I’d recommend having some Fraxel treatments after this procedure is done and healed to get rid of the scarring.
I would seriously investigate the credentials of someone offering this procedure which is considered by most Esthetic Physicians to be outdated. Once considered the gold standard in acne scar treatment, dermabrasion is now thought of as antiquated. It causes pigmentation changes in medium and darker skin tones. The “down time” is also considerably more than a Fraxel treatment.
Esthetic Dermatology or Medi-Spa Treatments:
Microdermabrasion is a cosmetic procedure performed at day spas as well as in Esthetic Dermatologists’ offices. A machine is used to discharge ultra-fine aluminum oxide crystals through a tube and onto the skin. The crystals are simultaneously vacuumed away. A series of treatments is needed and this is not going to significantly impact acne scars or “pits.” Because only the surface skin cells are removed, the main benefits of microdermabrasion are for de-pigmentation. As you read the rest of this article you’ll note that there is some overlap with office and home techniques. I’m putting microdermabrasion as an office procedure because I just haven’t seen any home-use machines that produce decent results.
This is the newest , “hippest” skin resurfacing, collagen stimulating, scar and stretch-mark therapy. It might even work to reduce the appearance of cellulite! Microneedling therapy is a minimally invasive skin-rejuvenation procedure. The device that is used contains rapidly-pulsating fine needles. The needles are used to puncture the skin to create a controlled skin injury. Each puncture creates a channel which then triggers the body to fill these teensy wounds by making new collagen and elastin.
You will see improvement in skin texture and firmness, as well as reduction in scars, stretch marks and facial pore size. The healing process with this procedure has been demonstrated to be assisted up to 50% with Lifeline Proplus Skincare serums. Unpublished data shows that these growth factor products speed up healing for all laser procedures as well, by the way. Microneedling procedures are performed in an office setting. It is cost-effective, and as a bonus, can be done on areas of skin that may not be suitable for laser resurfacing, such as around the eyes and mouth.
The procedure is well tolerated by patients with minimal downtime, and is personalized by going deeper on some areas where acne scars require a more aggressive approach. Topical anesthetic cream is used to keep the patient comfortable during the procedure. Multiple treatments will be necessary. The number of needling sessions depends on the individual skin condition. Three or four treatments are generally what’s needed for mild to moderate acne scarring. Deeper scars and stretch marks may require upward of five treatments. An interval of 4 to 6 weeks between treatments is typical to allow for maximal collagen and elastin regeneration. A microneedling treatment on the face costs around $300.
Once you have taken the initial steps, dermal fillers with hyaluronic acid, calcium or collagen (outdated-don’t use) can fill in “gaps” here and there. The newest hyaluronic- based filler is called Volumina and lasts far and away the longest of everything other than Bellafill. Bellafill is touted to last for 5 years but I wouldn’t recommend it for acne scarring because your face will change over the next five years. Unless you are in your 20’s I’d be nervous about what this filler will look like. Depending on how much filler you need, you are looking at $500-$4000 but again, expect this to smooth things out in the hands of someone with good technique.
What you can do at home:
Dermarolling stimulates collagen production in the skin. It is accomplished by piercing the skin using the roller’s micro-needles and breaking down fine wrinkles, sun damaged skin, acne spots and some types of acne scars to induce tremendous collagen production. The skin needling treatment recommendation for home use is 0.25 mm to 1.0 mm needles. However, once you know what you’re doing (it’s easy!) you can use the 1.5 mm rollers at home. If you use 1.5 mm needles, you’ll need skin numbing cream. The numbing creams are also called topical anesthetic creams or ointments. They can be found online, on the same sites you purchase titanium needle “rollers.”
Derma- rolling produces a fresh layer of collagen underneath the epidermis. The newly created collagen layer will thicken the skin and will fill or reduce skin imperfections with varying amounts of treatments. I put this as a home treatment because for a fraction of what is charged “in office”, using 2.0 mm needles, you can do this yourself. It is an integral part of my recommended anti aging skincare regimen and there are lots of Youtube videos to show you exactly how to do it.
Lotions and potions:
Hydroquinone has been a popular skin lightener, used for hyper-pigmentation and prescribed to fade acne scars. It has recently fallen out of favor and is now being omitted from many fading creams. Why? It’s quite irritating but the real reason is that it’s a real, known carcinogen. However, there are other non-toxic ingredients in skin creams sold without a prescription that can help lighten your dark spots.
Kojic acid (a natural skin lightener derived from mushroom extract) is one. Asaf(o)etida (Ferula Assa-Foetida Extract),Perilla Ocymoides Leaf Extract and Sweet flag-Calamus and Glycyrrhiza Glabra Root Extract—–Licorice Extract are all skin whiteners and all happen to be combined in our Moorspa radiance serum.
Vitamin C (ascorbic acid) is another great ingredient to look for in masks and serums. Don’t go too high on the topical C which many commercial products contain and you’ll have a great way to slowly de-pigment your skin. Consider exfoliating (a must for your regimen) with a Vitamin C Mask. It’s fine to have a briefly high skin concentration of vitamin C and that’s where a good mask comes in. This concentrated dose of Vitamin C is crucial when it comes to scar healing and depigmentation. The free radicals that Vitamin C helps to combat are the same ones that can cause severe and permanent cellular damage to your skin. Brief high doses of vitamin C have been shown to significantly fade acne scars.
Glycolic lotion is the best “hydroxy” topical to use to fade pigmentation and smooth out skin texture. It’s a powerful exfoliant which evens out the top and bottom area of a scar. It is also capable of removing some of the gray appearance often reported with scarring. Acne scars reportedly become flatter and less visible with the use of a glycolic acid product for 6 months to a year. You can also have in-office glycolic peels but again, it’s less expensive to use a good product daily and “do it yourself.”
The “other hydroxy” you can add if you have oily or normal/oily skin is a salicylic facial wash or lotion. Topical salicylic acid will help reduce the appearance of your acne scars. It exfoliates your skin and removes dead skin cells from the outer epidermal layers so your pores don’t plug up. The removal of these skin cells reduce the appearance of the surface scars and stimulate collagen production in the dermal layers.
Where to start?
It’s worth the money (and insurance will pay) to have an evaluation by an Esthetic Dermatologist. Sure, you can start using products and procedures at home as described above. However, a professional evaluation will be a good idea to guide you in the right direction as to the best procedures to get rid of your acne scarring once and for all.