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Acne is usually caused by hormonal changes and overly active sebaceous (oil) glands that affects up to 80% of people in their teens and up to 5% of older adults. There is considerable variation in scarring between one person and another, indicating that some people are more prone to scarring than others.

Acne scars can give the skin an “old” look and the face look rugged, which can indeed bring your self confidence at its lowest point. Scars may also contribute to an appearance of age as the skin loses its elasticity over the years.

There are two types of acne scars, classified by tissue response to inflammation:

1. Increased Tissue Formation

Scars caused by increased tissue formation are caused by a build up of collagen in the skin.  These are called hypertrophic and keloid scars. Overproduction of collagen is a response of skin cells to injury. The excess collagen becomes piled up in fibrous masses, resulting in a characteristic firm, smooth, usually irregularly-shaped scar. The typical keloid or hypertrophic scar is 1 to 2 millimeters in diameter, but some may be 1 centimeter or larger.

2. Scars Caused by Loss of Tissue

Ice-pick scars

Ice-pick scars more occur on the cheek. They are usually small, with a somewhat jagged edge and steep sides—like wounds from an ice pick. Ice-pick scars may be shallow or deep, and may be hard or soft to the touch.

Depressed fibrotic scars

They are usually quite large, with sharp edges and steep sides. They are similar in appearance to deep chicken pox scars.

Superficial and deep soft scars

They have gently sloping rolled edges that merge with normal skin. They are usually small, and either circular or linear in shape.

Atrophic macules

They are usually fairly small when they occur on the face, but may be a centimeter or larger on the body. They are soft, often with a slightly wrinkled base, and may be bluish in appearance due to blood vessels lying just under the scar. Over time, these scars change from bluish to ivory white in color in white-skinned people, and become much less obvious.

Follicular macular atrophy

They are more likely to occur on the chest or back of a person with acne. These are small, white, soft lesions, often barely raised above the surface of the skin—somewhat like whiteheads that didn’t fully develop.

There are many technique or combination of treatment used to improve acne scars. Treatment acne scars depends on the type of scar, quantity of scarring and the type of skin. No treatment is 100% effective and the best result is improvement, not perfection. It is very important for the patient to discuss a dermatologist for finding the most suitable and effective at treating or removing acne scars on the face.

Following are common techniques and procedures used to improve scarring:

1. Dermabrasion

Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that abrades the skin. As the skin heals from the procedure, the surface appears smoother and fresher.

2. Collagen Injections

Collagen, a normal substance of the body, is injected  beneath the skin to replace the body’s natural collagen that has been lost. Collagen derived from cows or other non-human sources cannot be used in people with autoimmune diseases.Injectable collagen is generally used to treat wrinkles, scars, and facial lines.

3. Autologous Fat Transfer

Fat is taken from another site on your own body and prepared for injection into your skin. The fat is injected beneath the surface of the skin to elevate depressed scars.  This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

4. Laser Resurfacing

Laser resurfacing (see section on Laser Resurfacing) has been used for the treatment of acne scarring. Laser resurfacing may be used to minimize wrinkles and fine scars. All lasers use a high-energy beam of light that targets specific structures in the skin. Like dermabrasion, laser resurfacing is ablative meaning that it destroys the outer layers of the skin.

5. Microdermabrasion

Microdermabrasion is a popular procedure which is classified as light, or very superficial dermabrasion. This method employs aluminum oxide crystals that are propelled at the skin and immediately sucked up. Although not scientifically proven to improve the appearance of skin, many patients report that their skin feels smoother. It is used to treat acne, and the hyperpigmentation caused by acne. It is also popular because it is painless and there is no recovery time after the procedure.

6. Chemical Peels

Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. Many different chemicals are used including glycolic acid, trichloroacetic acid (TCA), salicylic acid, “Jessners” solution, and phenol. Medium depth and deep peels produce injury within the dermis and can improve the appearance of atrophic acne scars. The deeper peels are more effective but carry more risks such as infection, scarring, and discoloration, especially for patients with dark skin. 

7. Punch Grafts

Punch grafts are small skin grafts used to replace scarred skin. Larger scars can be removed and then filled with a skin graft, taken from skin (usually behind the ear). Grafts are later contoured with dermabrasion to blend them into the rest of the skin.  Punch grafts can help treat deep acne scars.

8. Subcision

Subcision is a technique in which a surgical probe is used to lift the scar tissue away from unscarred skin, thus elevating a depressed scar. Subcision is used for atrophic scarring. Local anesthesia is used and a needle is then inserted under the scar and gently moved underneath the skin to release the scar tissue.


 
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