Acne scars are stubborn reminders of past breakouts and blemishes that affect nearly 50 million Americans and seem impossible to remove, but with tailored treatment, clearer skin is possible for every type of scarring. New York Dermatologist and Cosmetic Surgeon Dr. Cameron Rokhsar, M.D., explains the latest breakthrough techniques for improvement of acne scars and how important it is to take care of post-breakout skin.
Acne scars can seem like one skin problem after another. First, it’s difficult enough to deal with acne, a common skin disorder that plagues many teenagers and even some people into their adulthood. Then, after the blemishes, whiteheads, blackheads, inflamed pimples, and nodules have finally disappeared, scars remain on the skin. Many are discouraged by futile attempts at scar treatment, especially because acne is the most common skin disorder affecting adolescents and young adults.
Because acne scars can range from deep pits to angular or wave-like scars, treatment options completely depend on the type of scar. Acne can leave behind deep scars, which can worsen with age and sun exposure. While acne is not a life-threatening condition, in its severe form, it can lead to serious permanent scarring. In milder cases, scarring can be unavoidable and treatment options should be explored in order to choose the correct approach.
Scars are mainly composed of abnormal and damaged collagen. Collagen is a protein, which is one of the components that provides structure to the skin and is found in the deeper skin layers. Scars are formed from damaged and deformed collagen in response to the inflammation acne causes. People with darker skin tones, such as those with Black or Hispanic ethnicities, sometimes experience noticeable darkening or hyperpigmentation within the scars, while people with lighter skin, such as those with light eyes and freckles, may show redness or erythema within the scars.
Even with a conscientious effort and careful treatment, acne scars can still occur with varying types. Scars generally form two different ways; either they are caused by a loss of tissue, which is commonly referred to as atrophic scars, or they are caused by an excess of tissue, which is commonly referred to as hypertrophic scars. Hypertrophic scars usually appear on the nose and chin, which can cause an embarrassing and noticeably bumpy build up of tissue. Each scar type needs a specific treatment approach that completely depends upon the type of damage acne left behind. Atrophic acne scars are typically classified into three categories: boxcar, rolling, and ice pick scars.
1. Boxcar: Round, or oval depressions with steep vertical sides appear wider than ice pick scars and give the skin a pit appearance. Inflammatory breakouts destroy collagen, which leave behind a depressed area. They can vary from superficial to severe pits, depending on how much tissue was lost in the breakout. Laser resurfacing is the best course of treatment for boxcar scars because they address the damaged layer of skin by stimulating new collagen production.
2. Rolling: Characterized by wave-like or rolling undulations across an otherwise normal layer of skin. They arise when fibrous bands of tissue develop between the skin and subcutaneous layer, which pull on the epidermis. This pulling of the top layer of skin into the deeper structures creates the uneven rolling.
In this case, subcision is the best treatment option. A small needle is inserted underneath the rolling scar to lift up the skin. This stimulates normal tissue to regenerate and lift the scarred area, which allows the skin to naturally heal back into an even layer.
3. Ice Pick: Dark, very narrow scars that extend into the dermis. The skin appears as if it has been pierced by a sharp instrument, which has left small deep, holes into the skin. They typically develop after an infection from a cyst or deeply inflamed blemish.
Ice pick scars are best treated with punch excision, a surgical procedure used for deep acne scars. A punch biopsy tool is used to cut out the scars, then the normal edges of the skin are stitched together, all while the patient is under local anesthesia. The edges of the skin that are sewn together are undamaged by scarring so that they are able to neatly heal through a normal and controlled healing process. There will be a scar following the procedure, however it will eventually fade and become less noticeable than the original acne scar. The new scar will be able to respond to laser therapies such as Fraxel Re:store treatments much better than the acne scar.
Lasers are a commonly used modality in the treatment of acne scars. Laser resurfacing, such as Fraxel, has revolutionized the treatment of acne scars, as well as wrinkles, surgical scars, melasma and other skin conditions. This laser utilizes a wavelength that penetrates deep into the tissue to create tiny zones of micro-damage. The new damage stimulates a healing process, in which the body naturally creates new collagen and elastin that remodels the skin’s surface and leaves behind a smoother surface. Recovery is minimal with a sunburn-like condition that lasts up to a few days after treatment.
Dr. Cameron Rokhsar is regarded as an international authority on the use of the Fraxel laser and has taught more physicians on its use than any other physician in the world. Fraxel Re:store can treat scarring in three to five sessions, while Fraxel Re:pair results can be seen within one to two treatments. However, Fraxel Re:pair uses a different wavelength, which means it can leave the skin raw for a few days and will require patient downtime.
“It is a common misconception that creams can effectively treat the scars acne leaves behind,” says Dr. Rokhsar. “It is only through a proper assessment of a patient’s scars, that a correct treatment approach can be implemented to achieve desired results.”
The V-Beam, also known as the pulsed dye laser, is another non-invasive treatment option for acne scars. Instead of addressing deep pits and uneven surfaces, V-Beam most affectively treats the redness from breakout inflammation. The redness left behind from acne is a result of tiny broken capillaries at the site of the healed acne lesion, which is more common and more visibly noticeable with newer acne scars. The V-Beam laser treats the red acne scar with its dual cooling and deep heating process that targets and treats the broken vessels within one to three treatments.
Contrary to popular belief, microdermabrasion and chemical peels aren’t the ideal treatments for acne scars, as they only strip the top layer of skin off and without treating the actual deep rooted problem. Microdermabrasion is an exfoliating treatments that is used to gently sand the skin, followed by a small vacuum that sucks up dead cells and debris. It works best for superficial wrinkles, scars, and mild acne. Chemical peels are used to treat similar conditions resulting in a smoother skin surface, but do not affectively treat acne scars, which require deeper treatments.
The best treatment for acne scars is of course prevention. An estimated 95 percent of all acne sufferers will develop a scar to some extent, which makes it seem impossible to breakout without a mark. However, early treatment, through a qualified dermatologist is the best preventative measure. When scars inevitably persist and seem impossible to erase, scar type identification and appropriate treatment are the solution.
Dr. Cameron K. Rokhsar, M.D., is the leading authority in laser surgery and non-invasive techniques, Dr. Rokhsar, has extensive training and expertise in the field of skin resurfacing, tightening and scar treatment. A graduate of Harvard and New York University, Dr. Rokhsar is a fellowship-trained dermatologist and laser surgeon and extensively published medical author and Professor of Dermatology at Albert Einstein College of Medicine. His offices are located in New York City and Garden City, Long Island.