Types of Acne Scars And Treatments
Acne scars are red, or hyperpigmented marks on the skin that occurs after an acne lesion has healed. It is actually not a scar, but rather a post-inflammatory change. The redness or hyperpigmentation is seen as the skin goes through its healing and remodeling process, which takes approximately 6-12 months. If no more acne lesions develop in that area, the skin can heal normally. Any color change or skin defect still present after 1 year is considered to be a permanent defect or scar.
Acne Scar Classifications
Icepick - Narrow, sharp scars that make the skin appear as if it has been punctured with an icepick. Icepick scars are usually too deep to correct with skin resurfacing treatments such as dermabrasion or laser resurfacing.
Boxcar - Round to oval depressions that have sharp vertical edges. Unlike icepick scars, they do not taper to a point at the base. Shallow boxcar scars can usually be treated with conventional skin resurfacing techniques. Deep boxcar scars require full-thickness treatment techniques.
Rolling - Occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance. Conventional skin resurfacing techniques do not work on rolling scars. They must be corrected by breaking up the subcutaneous fibrous bands.
Acne Scar Treatment Procedures
There are numerous procedures that can be used to correct acne scars. Each procedure has its own risks and benefits, and several procedures are normally combined to create the smoothest appearing skin.
Dermal Fillers - Dermal fillers are injected into acne scars to raise the surface of the skin and give it a smoother look. The injection of dermal fillers does not permanently correct acne scars, so further injections are necessary.
Punch Excision - Used on deep scars such as icepick and deep boxcar scars. Under local anesthesia, the scar is excised with a punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable. If it is noticeable, it is more amenable now to resurfacing techniques.
Punch Elevation - Used on deep boxcar scars that have sharp edges and normal appearing bases. The same punch tool is used to excise the base of the scar leaving the walls of the scar intact. The excised base is then elevated to the surface of the skin and attached with sutures, steri-strips, or skin glue called Dermabond.
Subcutaneous Incision - Used to break up the fibrous bands that cause rolling scars. Subcision is performed under local anesthesia by inserting a specially beveled needle under the skin so that it is parallel to the skin surface. Staying in the plane between the dermis and the subcutaneous tissue, the needle is gently advanced and retracted in a piston-like motion cutting the tethering bands.
Laser Resurfacing - Work by essentially burning the top layers of skin to a precise depth. The skin then heals replacing the burned layers with newer appearing skin.
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