Acne scars are stubborn and no single treatment is best for everyone. One or a combination of the following approaches might improve the appearance of your skin, depending on your scar type, your skin type, and the severity of the scarring. Scars are formed when a breakout penetrates the skin deeply and damages the tissues beneath it.
Factors responsible for treatment outcomes
Types of scars: Before you try to treat your scars, it’s important to know what type they are. Each type responds to treatment differently, and some treatments are better for particular types than others.
Skin tone: For darker skin types, deeper skin laser treatments will not be recommended due to higher chances of scarring and pigmentation.
Different types of scars
1. Atrophic rolling
2. Box scars - deep depression in skin
3. Ice pick scars - look like pores most difficult to treat
4. Hypertrophic or raised acne scars commonly found on back, chest and are associated with hyperpigmentation
Scars can’t be treated with one particular modality it always has to be combined with different modalities. Following are some of them
Chemical peel: Chemical peels like alpha and beta hydroxy acids, trichloro acetic acid, phenol peels improve the texture, appearance, and pigmentation of the skin and lightened acne scars. These are best for atrophic and pigmented scars, post-inflammatory hyperpigmentation.
Dermabrasion: Dermatologists use tools to more deeply exfoliate the top layer of the skin. This is best for scars close to the surface like shallow boxcar or rolling scars. But deeper scars may also become less noticeable.
Laser resurfacing: Laser resurfacing like Fractional CO2 and Erbium Yag also works. Much like a chemical peel and dermabrasion, laser resurfacing removes the top layer of the skin. This treatment typically has a faster healing time than other resurfacing treatments. This treatment is also not a good option for anyone who’s still getting breakouts, and it’s not as effective on darker skin tones. Best for all acne scars and lighter skin tones.
Microneedling: This newer treatment uses a small, handheld, needle-studded roller or a handheld ‘pen’ on the surface of the scars. The needles puncture the numbed skin — but don’t go through it like a shot. As the skin heals, it makes collagen. There’s evidence that suggests microneedling helps reduce the depth of acne scars. This treatment can take up to nine months for the changes to reflect. Outside of the slight fear factor, it’s a safe treatment that works for all skin tones.
Fillers: Dermatologist use fillers to fill in acne scars and help even out the skin. The fillers can be made with collagen, your own fat, or a commercial filler. They’re injected under the surface of the skin to help plump up and smooth out depressed scars. Most fillers last between 6 and 18 months before they need to be redone, but some are permanent.
This is best for someone with a small number of boxcar or rolling scars, and depressed acne scars.
Injections: There are a few different medications that can be injected into raised scars to help soften and flatten them, including corticosteroids and chemotherapy drugs fluorouracil (5-FU) and interferons. The injections are usually performed as a series, with one every few weeks, and works best on raised scars.
Subscision: The dermatologist can also lift the scar by loosening fibres beneath it to bring it closer to the surface, so it’s less noticeable. This procedure is called subcision and is good for deep, depressed, and raised scars.
The best way to treat an acne scar is to prevent it in the first place. You’re less likely to develop acne scars if you break out less. Avoid picking, popping, or squeezing any breakout, no matter how tempting, to prevent irritating the skin and damaging the underlying tissue, which can lead to scars.
(Dr Usha Beloskar is the Medical Director, Sskin Savvy Advanced Aesthetics, Kohinoor Square Dadar, Mumbai)
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