Are you plagued by permanent scars left behind from the acne you struggled with as an adolescent or teenager? Maybe your skin has been marred by adult onset acne, such as during pregnancy. In fact, acne can occur in your 30s and 40s and can appear in other places beside your face, such as on your back or chest. Even though your acne may have cleared up long ago, the resultant scars can be devastating and cause a lifetime of grief and embarrassment. The scars may also worsen with age as your skin loses its elasticity.
Acne scars are caused by inflammation. The inflammation occurs when a pore fills up with oil, dead skin cells and bacteria. The infected material can leak out into the dermis, destroying healthy tissue. The greater the inflammation on the skin, the more likely you are to develop scars. The skin generates new collagen in an attempt to repair the damage, but it does not always do a perfect job. Sometimes our bodies produce too much collagen which results in raised scars called hypertrophic, or keloid, scars.
All acne scars are not alike. Some are small and shallow. Some are discolored, dark or pigmented. Others scars are small in diameter but deep (commonly referred to as “ice-pick” scars because they look like ice-pick wounds), or large and saucer-like, similar to chicken pox scars.
It may be impossible to completely erase any of these acne scars but, whether your scars are mild or severe, you have many options available today to improve the appearance of your acne scars. Some procedures have been available for a long time; others are new and showing great promise. Acne scarring has most often been treated with excision, dermabrasion and chemical peels. However, there are some newer alternatives using fillers and non-ablative laser treatments that may help. There are even some methods you can try at home.
Before you get started with treating your acne scars, you must make sure your acne is resolved. You will find the greatest satisfaction if your acne has not been active for at least 3 months. If you continue to suffer from acne outbreaks, scarring can continue to happen and any scar treatment you have may end up being ineffective and pointless. Seek treatment to make sure your acne is under control.
Below we will discuss the many acne scar treatment methods, their costs, effectiveness, risks, and any other factors you should consider. Your skin type and complexion, your skin’s healing abilities, and how much downtime you can tolerate will all be important factors in your decision.
Keep in mind that no single doctor will offer all of these treatments. Do your research and consult with board-certified dermatologists and plastic surgeons to learn as much as you possibly can about which method will be most beneficial for you. This will help to ensure the best outcome for your acne scar reduction or removal.
Long considered to be the “gold standard” for acne scar treatment, dermabrasion is still in regular use today but is gradually being replaced by laser treatment. It may be very effective, however, depending upon your skin condition and the type of acne scars involved.
- What it is: Dermabrasion mechanically removes the damaged outer layers of skin by using high-speed diamond or wire wheels or brushes.
- Effective for: Dermabrasion can be very effective for superficial and hypertrophic acne scars and, when combined with punch excision, can also benefit ice-pick scars.
- Side Effects/Risks: You could experience hyperpigmentation (darkening) or hypopigmentation (lightening) of the skin that may be temporary or permanent, pain, infection, raised or keloid scarring, and increased sensitivity to sunlight.
- Recovery: Dressing is applied. Treated skin will flake off within about 2 weeks and will gradually be replaced with new, softer skin over a period of several months. You may have redness for up to 9 months after treatment. Sunscreen should be applied daily for 6 months to one year following treatment.
- Estimated Cost: About $1,500 per treatment. Repeat treatment may be necessary.
Although it sounds like dermabrasion, microdermabrasion is very different.
- What it is: Microdermabrasion is a very superficial treatment that “sands” the surface of the skin with tiny aluminum oxide crystals and collects the debris with a small vacuum pump. You will often find microdermabrasion offered as a spa treatment, performed by estheticians.
- Effective for: Microdermabrasion can be helpful for treating acne, can improve the surface texture of the skin and may improve the appearance of superficial acne scars, but has little effect on deeper scars.
- Side Effects/Risks: Treatment may cause a stinging or burning sensation, redness, or uneven patches of skin. Microdermabrasion will also increase sensitivity to sunlight.
- Recovery: Your skin may have pink patches for several days.
- Estimated Costs: Expect to pay $50 to $300 per treatment. This depends on where you live and who is doing the procedure. At an average cost of $120 per session, a complete treatment program will cost about $1,600.
Chemical peels are usually safe when performed by a qualified plastic surgeon and can be useful for improving small scars as well as some deeper scars, although they are not usually as effective on ice-pick or deep fibrotic scars. Light and medium chemical peels are designed to improve skin imperfections and may not have any significant effect on scars. Deep peels, as the name implies, can remove deeper layers of skin, causing new skin to grow and thus improving some acne scars. Chemical peels are not usually done on keloid scars. Chemical peels may also be used to treat active acne by removing blackheads and whiteheads.
- What it is: A chemical acid solution is used to remove damaged surface layers of skin. Light peels using salicylic, glycolic or trichloroacetic acids are mostly superficial and, while they help dry up active acne, have little more than a softening effect on acne scars. Medium peels generally use trichloroacetic acid (TCA) in a higher strength. Both light and medium peels are often performed by dermatologists or estheticians. Deep chemical peel solutions apply extremely acidic solutions (TCA or phenol) and must be very carefully administered by a plastic surgeon or dermatologist. Phenol is primarily used on the face; using it on other parts of the body may cause scarring.
- Effective for: Facial blemishes, uneven skin pigmentation and small, depressed scars. Deep peels are not recommended for darker skinned patients due to the likelihood of hypopigmentation (lightening).
- Side Effects/Risks: Light and medium peels may cause peeling and flaking for 1 to 10 days, redness, itching, tightness, hyperpigmentation (darkening) of skin, increased sensitivity to sunlight. Deep peels can be extremely painful and your doctor may use heavy sedation or general anesthesia to reduce your pain. Other deep peel side effects include inflammation, swelling, infection, skin atrophy, scarring, and loss of ability to tan. Phenol can be toxic to the kidneys and may be particularly risky for patients with heart problems.
- Recovery: Light and medium peels may take 10 or 15 minutes. You will probably experience redness followed by peeling of the skin for about 1 week. Sun block should be applied daily following treatment. Deep peels may take one hour or more and you should have someone available to drive you home after the procedure. Your skin will form a crust which will flake off in about 2 weeks after treatment. Complete healing will take several months. You must avoid sunlight after treatment, and should plan to apply daily sun block for the long term.
- Estimated Costs: Light peels – $50 to $200 per treatment. Medium peels – $150 to $900 per treatment session. You will usually need repeated sessions of light and medium chemical peels. Deep peels – $2,500 to $6,000 for full face treatment. Deep chemical peels should be done once.
Some states impose no special requirements for providers of chemical peels, even deep peels. You should do adequate research to find a properly trained physician who specializes in the area of acne scar treatment.
Advancements in laser technology in recent years may offer you very effective treatment options for your acne scars. There are several types of lasers that all work in different ways, although non-ablative laser treatments are preferred today. Ablative lasers carry a higher level of risk and may not be as effective at scar removal. Laser resurfacing can be very expensive, and results may vary.
- What it is: Ablative lasers heat and destroy the top layers of skin, allowing new scar-free skin to form. Carbon dioxide (CO2) lasers and Erbium (YAG) lasers are most often used for this purpose, with CO2 lasers being the more powerful and carrying more severe side effects. Non-ablative lasers such as pulsed-dye and fractionated lasers can be used to penetrate the skin tissue and stimulate collagen growth which will elevate depressed scars, raising them to the level of surrounding skin tissue. Treatments can take a few minutes for small areas to about one hour for larger areas.
- Effective for: Non-ablative laser are best for mild to moderate atrophic scars with loss of tissue and red scars. Ablative lasers are best suited for hypertrophic (thickened) scars.
- Side Effects/Risks: Oozing, redness, infection, stinging, swelling, dilated blood vessels, hyperpigmentation (usually resolves in a few months), hypopigmentation (usually less apparent with Er:YAG laser), and hypertrophic scarring.
- Recovery: Non-ablative treatment will have mild side effects and you can usually go back to work immediately following a session. Skin will continue to improve after treatment as a result of collagen stimulation. Ablative laser treatment – Ointment and dressing may be applied for several days while your skin heals. Redness/pinkness can last from several weeks to several months. Recovery time can take several weeks and may be longer following CO2 laser resurfacing.
- Estimated Costs: Non-ablative – $400 to $600 per treatment; may take 3 to 5 sessions. Ablative – $3,000 to $6,000 per treatment. Can be repeated after 6 months.
Subcision is commonly combined with dermabrasion or laser treatment.
- What it is: The scarred skin is surgically detached or cut away from the deeper scar tissue below. Once freed, the space underneath can be filled by blood, saline or a filler material to level out the scar with the surrounding skin and to keep the scar from forming again.
- Effective for: Fibrous and depressed scars; deep, rolling scars
- Side Effects/Risks: Bruising, swelling, hypertrophic (raised) scarring, discoloration
- Recovery: Bruising and swelling may last for several weeks
- Estimated Costs: $50 to $750; may require repeat treatments
Punch Excision and Elevation
Deeper ice-pick type acne scars can be surgically removed by excision. The skin will either be sutured and allowed to heal or replaced with a skin graft. Instead of suturing or grafting, punch “elevation” reduces the depth of the scar by removing it, elevating it, and reattaching it.
- What it is: Scars are surgically excised with a punch biopsy tool.
- Effective for: Deep ice-pick and boxcar type scars
- Side Effects/Risks: Bruising, possible keloid scar formation, excision may leave a new scar which could require further treatment, skin graft failure
- Recovery: Sutures are removed after one week. It generally takes 4 to 8 weeks to heal.
- Estimated Costs: $200 to $300 per scar
Collagen induction therapy (a.k.a. medical needling/rolling)
This therapy stimulates your body’s own production of collagen by causing tiny injuries to the skin using a sterile roller covered with needles. The patient is anesthetized and the procedure takes from 10 to 60 minutes. It can take several months to see results because it takes time for the body to generate new collagen. The average cost is $200 per treatment.
To help elevate depressed scars, a variety of injections are available. Hyaluronic acid fillers such as Restylane, collagen fillers, or even fat from somewhere on your own body can be injected under the skin. All of these fillers will be absorbed by your body over time and would have to be repeated. Costs vary based on the filler that is used and who is doing the procedure.
When excess collagen production causes keloid or hypertrophic scars, steroids can be injected into these scars or applied topically to soften them and reduce their size. Treatment can take a long time because injections must be spaced at least 6 weeks apart to avoid skin thinning or ulceration. The injection costs range from $25 to $150 each.
Creams for acne scar treatment can help fade superficial scars but have little to no effect on deeper, larger scars. Of course, creams can be inexpensive ($20 to $100), so they may be worth a try before you embark on more serious expensive treatments.
Vitamin E, egg whites, cucumbers, tomato juice, lemon juice, apple cider vinegar, and olive oil have all been said to help improve the texture of your skin and fade the appearance of mild acne scars.
With so many acne scar treatments available today, there is no reason to endure frustration and embarrassment. While it’s unlikely that the scars will disappear completely, they may be able to be reduced or faded by a competent dermatologist or cosmetic surgeon. Be diligent about researching all of your options along with the qualifications and expertise of the treating physician.