Acne scars and acne scar removal


1. Indented or atrophic scars:
Icepick– skin looks like it has been pricked with needles or has deep pores,
Boxcar– resembles a small fingerprint,
Rolling– pits in the skin with sloped sides.

When do acne scars appear and who gets them?

Genetic predisposition is an important factor in the formation of acne scars. In some patients, the form of acne is very mild but the scars that form after the inflammation subsides are significant.
Also, if the inflammatory process lasts a long time and if it is deep, and the acne treatment is inadequate, there is a greater chance of scarring. Scarring is characteristic of nodulocystic and conglobate acne which are the most severe forms of acne.

Popping or squeezing pimples can very easily lead to scarring.

What does the healing process after pimples look like?

In the beginning, a purple mark remains at the site of the acne nodule. Along with the purple mark, there is also a smaller or larger indentation on the skin. If a person is not prone to scarring, a smaller indentation disappears over the next 6 months and the purple colour on the surface of the skin fades. A strong inflammation causes larger indentation in most cases.

How are acne scars treated?

Earlier, there was a misconception that scars should not be treated until a year has passed since their appearance and the tissue has undergone a final change. It is now reliably known that if a scar is treated immediately after its formation, there is a greater chance of replacing scar collagen with healthy collagen, and thus significantly reducing the potential for leaving lasting effects on the skin.

Vbeam pulsed dye laser is primarily used in this battle. The long-lasting purple spots fade within two weeks of the laser treatment. In order for the scar to fade almost completely, it is necessary to perform two to three treatments one month apart. Immediately after the treatment, the spots become darker than they previously were and then fade over 7 days. The Vbeam pulsed dye laser strongly stimulates the production of new collagen, which enables the filling of treated indentations.

Chemical peel can be done in combination with laser treatment. If the face is still covered with pustules, peels such as fruit acids, beta acids or salicylic peels are chosen. These are acids that can be used as an adjunct to acne treatment, while also exfoliating the skin and creating new collagen.

If there are no purulent processes on the face, a significant improvement in the appearance of the skin is achieved with trichloroacetic acid (TCA) peel.
Regardless of the acid used, it takes 7 days for a complete recovery of the face.
In these 7 days, the person can perform his/her usual activities to the full extent, but it is noticeable that the face has undergone a treatment.

Fractional CO2 laseras the most powerful tool in solving acne scars can very successfully treat both fresh and old scars.

As we age, natural loss of collagen occurs and old scars become much more visible. All these procedures restore collagen, and the more pronounced the effect, the greater the result.
Somewhat milder procedures are dermapen and PRP.

Dermapen is a procedure in which mechanical damage to the skin is performed using very thin needles of various lengths. Before the procedure, an anesthetic cream is applied locally. Skin responds to mechanical trauma by accumulating growth factors and stimulating new tissue. Redness disappears 3 days after the dermapen treatment.

PRP is a treatment that involves applying patient’s own platelets using thin needles. It is very often combined with dermapen and is suitable for treatments performed in the summer. It takes several treatments in order to obtain a visible result, however a complete result can never be achieved.

Surgical methods such as subcision and incision are used in case of wide and deep old scars. If performed on a properly selected patient, they can give good results. After surgical procedures, it is always desirable to perform one of the above procedures in order to treat the skin from the effects of the surgery itself.


Mayo Clinic, Acne

Acne Scarring—Pathogenesis, Evaluation, and Treatment Options

A systematic review of treatments for acne scarring. Part 1: Non-energy-based techniques

A Review and Update of Treatment Options Using the Acne Scar Classification System

Pilot Study Investigating the Efficacy of Fat Grafting as a Treatment for Male and Female Facial Acne Scarring

Svetlana Đurišić specijalista dermatovenerologije

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