Acne Scars 101: Types, Possible Treatment Options And More
Can acne scars heal naturally on its own?
A consequence of acne is scarring. Acne and acne scarring can have a negative impact on the quality of life and lead to feelings of anxiety and low self-esteem. When patients think of scars, they usually commonly mean either one of two things –atrophic scars (scars that cause indentation on the skin) or colour pigment scars.
Both types of scars can be troubling to patients. The next question that patients often ask is can these acne scars heal naturally. This article serves to shed some light on this question.
Types of depressed acne scars
There are three main types of atrophic acne scars – ice-pick, rolling, and boxcar scars. This classification system has allowed a consistent way of tailoring a specific treatment regime for each patient. Unfortunately, such acne scars are permanent and are unable to heal naturally. Nonetheless, there are various treatments that can be done to improve the appearance of the different type of atrophic scars. While the scars can never go back to normal skin, treatments exist to improve the overall appearance of the scars, boosting self-confidence in the process. Some treatments are specific to a type of scar, while other treatments can apply to all atrophic acne scars in general.
Ice-pick scars are narrow scars in the skin. They appear as though someone has used a sharp ice-pick to poke into the skin. TCA cross has been shown to improve the appearance of it. High concentrations of TCA is applied into each individual ice-pick scar, and white frosting is observed. The TCA causes coagulative necrosis of the epidermis, and the resultant wound healing causes an increase in the production of collagen and improvement in scar appearance. There are potential unpleasant risks like discolouration, redness and leading to more scarring instead.
Rolling scars are scars that appear as though there are ripples on the skin. Treatment is aimed at releasing the abnormal fibrous anchoring the skin that give rise to rolling scars. Subcision is helpful in release such fibrous strands. It involves the use of a needle to free the tethering subdermal fibrous bands. The needle is placed in a horizontal plane in the upper subcutaneous layer and moved in a gentle back and forth manner parallel to the skin to release the fibrous bands. Usually, several treatments are required. Subcision works best for rolling scars and is less effective for deep boxcar scars and icepick scars.
Boxcar scars are depressions with sharply defined vertical edges. They appear as though a portion of the skin has been carved out. Boxcar scars can be shallow or deep. Micro-needling radiofrequency technology works well on boxcar scars. Micro-needling consists of a sterile device with fine sharp needles that are applied to the acne scars to create multiple micro punctures in the skin. By creating these small wounds, the healing process is initiated that results in collagen stimulation and production, smoothening the appearance of the scars. At the same time, with the radiofrequency energy emitted from the device, the dermis is heated, causing neocollagenesis, further improving appearance of the scars.
Treatments options for different types of depressed acne scars
At The Clifford Clinic, we have the SECRET RF and INIFNI micro-needling radiofrequency systems that can help to improve boxcar appearances.
Differences between Secret RF and INFINI acne scar removal treatments
The difference between SECRET RF and INFINI is that the micro-needle of SECRET has RF energy transmitted along the entirety of the needle, while INIFNI has the RF energy focused on the tip of the needle. With the whole needle containing RF energy, the energy can weaken the oil glands that lead to acne outbreaks. As such, SECRET is recommended for patients who have acne outbreaks while wanting to have acne scar improvement. INFINI is recommended for patients whose acne outbreak is not as frequent.
Concealing acne scars with dermal filler
Sometimes, when any of the atrophic scar type is accompanied by significant tissue volume loss on the face, fillers can be a good treatment option. As the volume is replaced, the scars appear less deep, giving an improvement on the appearance of the scars. Combination with scar-specific treatments like subcision and microneedling radiofrequency also further help with the outcomes of the improvement. Some fillers can also stimulate collagen production to improve skin texture. They can also be used in combination with other laser procedures.
Acne scar removal lasers
Lasers are another treatment option for atrophic acne scarring. They are classified into the traditional ablative lasers that cause epidermal and dermal controlled damage, and non-ablative lasers that target the dermis but leave the epidermis intact.
Ablative lasers like the CO2 10,600-nm laser is a very traditional laser to treat acne scars. CO2 laser targets water in the skin causing dermal injury, along with damage to the epidermis, and in this process create the formation of new collagen.
Non-ablative lasers like the FRAXEL laser target tissue in the dermis by selective photothermolysis to stimulate collagen to reduce acne scar appearance. Non-ablative lasers are becoming more popular as they have a faster recovery time and a better side effect profile than ablative lasers. This suits patients who can’t afford to have too much downtime. However, more sessions are usually required.
Pico-MLA is another laser system that can help to improve scars. It involves using Laser-Induced Optical Breakdown to induce microscopic damage to the skin, stimulating repair and collagen formation in the process. As such, they are helpful in improving boxscar and ice-pick scars.
A combination of lasers, micro-needling radiofrequency and several acne specific treatments can help improve the overall outcome for the patient.
Treatment options for colour pigment acne marks
Another common thing that patient often refer to as scars are the coloured pigments that are left behind after the acne recovers. The colours are usually brown or red. Some patients have one colour more than the other or can have both colours at the same time. Such scars can heal over time on their own over time. However, the duration between each patient can vary. Some patients experience a long time before the pigments lightened, while some can be quick in terms of recovery.
The black pigments are called “post-inflammatory hyperpigmentation” (PIH) while the red pigments are called “post-inflammatory erythema” (PIE). To treat PIH, Q-switch or Pico laser are commonly used to speed up the recovery process.
To treat PIE, pulse dye laser like the V-beam can aid in clearing the pigments faster. The advantage about treating colour pigment scars is that there is no downtime associated with using the lasers, whereas to treat atrophic scars, downtime is inevitable as some damage to the skin needs to be induced for collagen stimulation to take place during the healing process. There is also no pain from the pigment lasers, whereas to treat atrophic scars, a layer of numbing cream to numb the face is necessary before doing treatment.
With lasers to treat the pigment scars, the pigments can clear up faster, and patients can get back to normal looking skin faster than without getting any laser done. While atrophic acne scars can’t be cured naturally, there are many ways and modalities to improve them. While colour pigments scars can heal naturally, lasers are often used to speed up the recovery process.
If you are looking for acne scar treatment in Singapore, schedule an appointment with us at 6532 2400 to speak to our doctors and find out more!