Repairing acne scars

Key Points

"When you talk about treating acne scars, you have to look at three different categories," says Christopher B. Harmon, M.D., of the Total Skin and Beauty Dermatology Center in Birmingham, Ala.

Ice pick scars, characterized by their narrow, deep "ice pick" appearance, are typically less than 2 mm wide and extend into the subcutaneous layer. "Treatment for these are punch grafting or punch excision," Dr. Harmon says, "which is removing the scar by cutting it out and sewing the skin together."

Boxcar scars are broader - 3 mm to 5 mm wide - with a sharp shoulder and a vertical wall, Dr. Harmon explains.

"A classic chickenpox scar is a good example," he says. "Typically, they are treated with a much wider range of treatments."

One technique, punch elevation, involves cutting out the base of the scar and lifting the depressed area to the surface, Dr. Harmon says. Then, dermabrasion or laser techniques can be used to recontour the wall of the scar so that it doesn't cast as much of a shadow, he adds.

Atrophic or undulating scars show up when the patient is 40 or 50 years old. "The skin loses elasticity and becomes lax," he says, "and laxity contributes to the depressed areas."

Injecting a filler such as collagen, hyaluronic acid or transferred fat is the best treatment for this type of scar, he says, though fillers require follow-up to maintain the correction.

"You can also use lasers - ablative and nonablative," Dr. Harmon says. "Nonablative lasers have no downtime, unlike the CO₂ laser that has real long recovery."

He also says ablative laser treatments can potentially lighten the skin in some ways or cause hyperpigmentation.

Dr. Harmon says it's important to have realistic expectations.

"We are doing surgery to get rid of a scar without creating a new scar, and that, by definition, is difficult," he explains.

Even so, the improvements are noticeable, he says. "A good rule of thumb is a 30 percent to 50 percent improvement in acne scarring." And that kind of difference can have an immense impact on quality of life, Dr. Harmon says.

"Acne scars are very common and have a huge psychosocial impact. Treatment can be immensely rewarding for both the patient and treating physician."