There are a number of dermatologic procedures that can help improve the appearance of scars. However, whether or not scars require treatment depend on a number of factors that need to be discussed with your physician.

These factors include

• The way you feel about your scars. Are the scars emotionally distressing to you or do they not bother you? Are you willing to live with your scars or are you willing to see if they will fade with time. These are decisions that you have to personally make.
• The severity of the scars. Are they disfiguring?
• Type of scars: Some scars respond better to treatment than others. Some scars such as keloids imply that treatment may result in more scarring.
• Dermatologist’s opinion. They can give you an objective assessment regarding whether or not your scars will improve with treatment. They can also help you decide which treatment will be the most effective for you.
• Finances. Usually most of these procedures are not covered by insurance because they are considered cosmetic in nature.
• Status of Acne: Treatment for scarring should only be performed once acne is completely resolved. There is no point in treating scars if they are to come back again.

Treatment options

There are a variety of dermatologic procedures that can help with acne scarring. It is important to note that scars are difficult to treat and they often cannot be improved with one treatment. One should also be aware that the goal is to give the skin a more acceptable appearance. It is usually not possible to make the skin look like it did prior to acne lesions but scar treatment will often improve the skin appearance. The procedures currently available are

1. Collegen injection: Collegen is a substance produced by the body. It can be injected to fill in certain scars. Collegen injections usually last 3-6 months after which subsequent injections are required at additional cost.
2. Filler injection: New substances on the market such as Restylane and Hylaform can be used to plump up scars. They often last longer than collegen.
3. Fat injection: Fat is taken from another site of your body and injected beneath the surface of the skin to elevate depressed scars. This procedure has to be repeated as fat is absorbed into the skin around 6-18 months after the injection.
4. Dermabrasion: Under a local anesthetic a high speed brush is passed over the skin. This helps remove superficial scars and can reduce deeper scars. Dermabrasion needs to be used carefully in darker skinned complexions as it can cause changes in pigmentation.
5. Chemical Peels: These can assist in improving the appearance of dark spots. However, chemical peels are usually not effective in treating atrophic or hypertrophic scars.
6. Microdermabrasion: This technique uses crystals passing through a vaccum tube to remove the surface layer of the skin. Usually no additional injury to the skin is created. Often multiple treatments are required. It can assist in treating superficial scars and dark spots but is not effective in managing deeper scars. Picture / Video
7. Skin surgery: Each scar is excised resulting in a hole in the skin which is then sutured or repaired with a skin graft. This procedure can be used in ice-pick scars.
8. Treatment of Keloids or Hypertrophic Scars: Some respond to steroid injections resulting in a flattening of the scar. Surgical excision is often not used as it can result in greater scarring.
9. Laser Skin Resurfacing: This is likely the best procedure to improve the appearance of atrophic scars such as ice-pick or boxcar types. Ablative lasers remove the outer layers of the skin. It uses high levels of energy to burn away scar tissue and stimulate production of collagen which will tighten the dermis, reducing the appearance of scarring. A topical anesthetic is applied to the skin an hour prior to the procedure. There is often redness after the procedure. The skin usually takes 3-7 days to heal. Pre and post pictures and video

Choosing a Physician

When treating acne scars, it is very important that you find a doctor who is well trained and experienced in these procedures. With the exception of chemical peels or microdermabrasion which can be performed by a nurse or physician or esthetician, the other procedures described here should be performed by a trained and accredited dermatologist. Many of these procedures can cause disfiguring results and even worse scarring if done by inadequately trained physicians. You should always ask for the physician’s credentials and experience to ensure you the best results.

Prevention

The best way to prevent or at least limit scarring is to treat acne as soon as possible and as long as needed. The more the inflammation is controlled, the greater chance there is of reducing scarring. Any individual who is scarring significantly from acne needs to be treated and often aggressively.