Acne scars are annoying, even traumatic, especially now that we’re all doing zoom calls. So what’s the best way to get rid of acne scars? (You can’t go incognito forever — it’s not a great career move.) We asked Dr. Steve for his expert advice.
In this article you'll learn:
- What an acne scar is
- The types of acne scars
- Why you should ignore Bio-oil acne scar treatment
- The deal with microneedling acne scars
- How subcision for acne scars works
- Why some men use filler for acne scars
- Whether laser treatment for acne scars is a good idea
- Retinol for acne scars — can it work?
- How to remove dark spots caused by pimples
What is an acne scar?
Dr. Steve answer: A scar is a collection of abnormal bundles of collagen formation in the dermis of the skin. So, essentially, scars are bad collagen — it's not organized correctly, it's either a little bit hypertrophic (a raised scar) or opposite, a little atrophic (indented scar).
Types of acne scars: Atrophic
When the skin is unable to repair tissue properly, it forms an atrophic scar — a depressed region that is often pitted. Cystic acne, not whiteheads or blackheads, is what often leads to scarring.
Atrophic scars are divided into the following three types:
Ice pick scar: The most common atrophic scar, small, deep V-shaped indentations that appear on the cheeks. Typically 2-mm wide, with a sharp border that continues to the deep dermis, ice pick scars are difficult to remove.
Boxcar scar: A wider indentation than ice pick scars, boxcar scars are round-oval depressions with strongly defined outlines. At up to 4.0 mm broad, they can be more difficult to remove than ice pick scars.
Rolling scar: The broadest of the atrophic scars, a rolling scar lacks definite boundaries, and therefore is the most difficult to remove.
Hypertrophic scars
These scars are lifted from the skin as a result of an excess of collagen generated during healing. Usually connected with body acne.
Keloid scars
Whereas hypertrophic scars are the same size as the pimples that created them, hypertrophic scars are bigger than the initial spot. Small bumps or may be severe and present with bubble-like skin swellings, a keloid can grow for weeks or years. Can be removed surgically, but reappearance is likely.
Treatment for acne scars: Does Bio-oil cream work?
Dr. Steve says: For scarring that’s very deep — icepick or boxcar scars — no cream is really going to make a difference. Things like Bio-Oil or Derma, the evidence is not very strong that they make a big difference.
However, there is some evidence that silicone gel sheeting, which hydrates the scar, makes it a little bit softer and improves the color. But the studies are not that well done on these creams, especially for the thicker scars.
Microneedling acne scars
Microneedling uses carbon dioxide to create a vaporized skin microchannel that leads to healing. “You create little holes via a stainless steel needle, and you apply that across the face to stimulate healing, said Dr. Steve. “Microneedling is a lot cheaper than fractal laser treatment, which requires $100,000 worth of machinery, whereas microneedles are probably a couple hundred dollars.”
Subcision for acne scars
Subcision involves inserting a small needle into your skin to release the acne scar from the underlying tissue. This allows your skin to rise and to diminish the appearance of the acne scar.
Dr. Steve says: “For a boxcar scar, subcision basically props up the skin. So imagine having scars that pull down the skin a little bit, just kind of cutting those in and then allowing that to fill in normally.”
Filler for acne scars
Dermal fillers are injected into the skin to raise depressed areas of acne scars or stimulate the skin’s natural production of collagen. Material used for filler can include silicone, hydrogel or sometimes fat from other parts of your body — depending on what your dermatologist suggests.
Dr. Steve says: “I think filler is a good tool for those bigger scars that are indented, so you can fill it and it props up the skin.”
Laser treatment for acne scars
Focal acne scar treatment (FAST) uses a CO2 laser to create microscopic holes in the skin and fill them with new collagen. This procedure has a history of positive outcomes for atrophic scars like ice pick and boxcar scars.
Retinol for acne scars — can it work?
With scarring that is much more superficial — small indentations, surface roughness, and dyspigmentation — retinoids can work. Here’s how:
Modulates collagen production: Retinol, the main ingredient in our Night Cream, modulates collagen synthesis to help stimulate the right kind of collagen production. This helps with smoothing the skin on superficial scars. As a result, you get less indentation and you promote healing.
Balances skin pigmentation: Retinol helps balance the skin pigmentation as it affects melanocytes (cells that produce melanin), so you get fewer prominent dark spots.
How to remove dark spots caused by pimples
Dark spots (clinically known as post-inflammatory hyperpigmentation or PiH) occur when the skin at the site of a pimple produces larger amounts of melanin, which can lead to darker skin color — a collagen mismatch that can take months, even years to fade.
While PIH can affect almost anyone, those with darker skin tend to be more commonly affected — they have more severe and persistent cases, and also have the most concerns about the pigment irregularities.
In most cases, the way to remove dark spots includes over the counter or prescription topical medications, hydroquinone therapy, and sun protection.
The sun protection helps because if you expose areas to the sun that are already dark, they actually get darker, and UV rays exacerbate the color mismatch. Sunscreen is important because you don't want to lose progress as your skin's healing.
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