Acne is a common condition that effects most people at some time in their lives. It is not fully understood why some people develop more severe acne than others. Acne scars not only the skin, but damage a person’s confidence and sense of well-being as well. It is imperative that first we treat the acne and bring it under control and then determine the treatment plan for the scarring left by the acne.
The Causes of Acne Scarring
In the simplest terms, scars form at the site of an injury to tissue. They are the visible reminders of injury and tissue repair. In the case of acne, the injury is caused by the body’s inflammatory response to bacteria and dead cells in the plugged sebaceous follicle. When tissue suffers an injury, the body rushes its repair kit to the injury site. Among the elements of the repair kit are white blood cells and an array of inflammatory molecules that have the task of repairing tissue and fighting infection. However, when their job is done they may leave a somewhat messy repair site in the form of fibrous scar tissue, or eroded tissue, hence the result is the acne scar.
Acne is an inflammatory condition which can progressively damage the skin layer. Following the inflammatory phase, acne scarring can develop when new protein/skin develops within the healing acne lesion resulting in the disfigurement of the skin surface. The treatment of the scarring and the subsequent severity of the scarring can be influenced by:
- Patient’s age, overall health, medical history
- Severity of scar
- Type of scar or presence of any active acne
- Realistic expectations of the outcome of acne scarring improvement.
Dr. Rucker began treating acne facial scars in 1985 using dermabrasion, which is a slight sanding of the skin, in order to smooth the surface. At that time, he also employed the chemical peel technique, treating approximately 1000 patients over the next five years.
In 1990 he incorporated laser technology, with the ability to add microscopic refinement and better control of the procedure, into his practice.
Results will vary.*
Types of Acne Scars
Scars caused by acne are more common than doctors once believed. Most people have acne scars that are mild, although some individuals have scars that look significant even to others. There are several types of acne scarring:
- Ice pick scars – deep pits that are the most common and classic signs of acne scarring.
- Box car scars – angular scars that usually occur on the temple and cheeks and can be either be superficial or deep. These are similar to chicken pox scars.
- Rolling scars – scars that give the skin a wave like appearance.
- Hypertrophic scarring – raised and usually inflamed or reddened scars. More common on the back or chest and present as thick, lumpy scars that sit above the surface of the skin.
It is also common for color changes to occur with an acne condition. Color changes come in three basic types.
- Post inflammatory erythema – pink and purple patches at the site of the acne lesion.
- Post inflammatory hyperpigmentation – brown –black discoloration at the site of the acne lesion.
- Post inflammatory hypopigmentation – white marks on the site of the healed acne lesion. This is very common in those with darker skin tones and those who tan easily. It can significantly worsen the appearance of the acne.
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Avoidance of Acne and Acne Scarring
There are many things that are believed to cause breakouts, with stress being at the very top of the list. People have busy life styles. They run off to the gym, sweat, clog up their pores and believe they have acne. Common cosmetic ingredients can stimulate an acne condition. Avoid products that contain ingredients such as D & C colored dyes and Isopropyl Myristate, which causes irritation. These oily ingredients are commonly found in non-mineral base powders, blushes, eye shadows and lipstick. If your skin is acne prone, it is important to avoid these ingredients in skin care products. There is no cure for acne, but we have learned to control the condition with proper skin care products and services. There are a number of natural approaches for treating acne that are being slowly recognized by the scientific community involving ingredients such as Vitamin A & C, Camphor, Sulfa, Tree Oil, Green Tea and lavender. Acidic, glycolic and enzyme peels also provide an effective approach to removing dead skin cells. Microdermabrasion is being used successfully to help unclog pores which allow congested follicles to clear and become less prone to developing acne.
Insurance Issues Relative to the Treatment of Acne Scars
It is our experience that insurance carriers may well cover the control of active acne, but will not cover the treatment or improvement of acne facial scarring.
Recommended Treatment of Acne Facial Scarring
Prior to any acne scar treatment any active acne must be controlled. This usually requires a course of oral antibiotics and individualized topical skin treatments to address the active acne. Following the preparation of the skin, we may propose any of the following treatments:
- Topical medications
- Dermal Planning (Radioplaning)
- Direct Excision
- Dermal Fillers
- Erbium Laser
- Punch Graft – is used to build up the base of the indented scar
There are multiple considerations in acne facial scarring, including patient’s age, skin type and type of scarring. Treatment options must be individualized for each patient to gain the best overall results.* We have developed a program which effectively treats all type of acne scarring and skin types. The program is tailored to the severity, size and depth of the scars. For the patient with minimal scarring, mild topical dermabrasion and micro laser peels may be an option. For the patient with deeper ice pick and scallop scars, we use a technique called radioplaning or dermal planning which employs a microscopically controlled smoothing of the skin by applying directed heat ablation. Treatment of ice pick scars may be amenable to small micrografts that fill in the deep depressions left by the pitted scar. The usual approach following the above treatment options is the Erbium Laser which is used to smooth in the overall result. The length or severity of your recovery depends on which treatment option you choose. If you choose light or non ablative options, your recovery will be much shorter. If you choose the more ablative procedures such as dermal planning, your recovery will be slightly more extensive.
*It is important that you speak to your surgeon about your options and your recovery before making your decision.
Risks and Complications of Acne Facial Scarring*
As with your recovery, risks will vary with the treatment option chosen.* Discuss the risks thoroughly with your surgeon before deciding on your procedure.
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*DISCLAIMER: Cosmetic and reconstructive surgery results can and will vary significantly between patients. Risks, potential complications, and/or permanent scarring are inherent with any surgical procedure. Before-and-after photographs are NOT guarantees that your results will be the same as or similar to another patient. Any and all information should be discussed in full detail with your surgeon prior to any procedure as the information found on this website is not a substitute for a personalized consultation and examination. Material on this website may include the views or opinions of other patients, parties, or specialists; external website links are not endorsements or under the control of Rucker MD Plastic Surgery Clinic.
If you have any questions about our disclaimers, procedures, recovery protocols, or before-and-after photographs, please do not hesitate to fill out our contact form or call our office (800-456-8222).
We look forward to assisting you with your cosmetic and reconstructive choices.