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Acne Scar Removal: Surgical and Cosmetic Treatment

The most effective treatment for acne scars is the surgical, cosmetic and laser treatments.

There are a number of surgical and cosmetic procedures for removal of acne scars.

There are many options for surgical and cosmetic removal of acne scars.
Acne Scars: Many options for Treatment.
Acne Scar Removal: Surgical and Cosmetological Treatments
  • Chemical peels
  • Dermabrasion
  • Exoderm Lift
  • Needle Subcision of Individual Acne Scars
  • Acne Scar Revision
  • Laser Resurfacing of Scars
  • Cryoslush
  • Soft-tissue augmentation
  • Intralesional steroid injection
  • Electrodesication
  • Excisional surgery in selected cases

These are some of the effective techniques used for acne scar removal. The choice of therapy depends upon the type of scar, depth of scar and the choice offered by your dermatologist.

Acne Scar Removal: Chemical Peels

If the scars are small or shallow, they may be treated with chemical peel (also known as chem-exfoliation or derma-peeling). Peeling is also effective in the treatment of stubborn comedones.

If the scarring is deep or extensive, the chemical peels may be repeated at regular intervals.

Certain chemical agents capable of peeling off the skin layers are applied in different strengths depending upon the depth of the lesions. Removal of superficial layers stimulate regeneration of new tissue underneath resulting in the formation of fresh, rejuvenated skin.

The main chemical used as peels are:

  • Trichlor Acetic Acid (TCA)
  • Glycolic acid
  • Phenol
  • Salicylic acid
  • Lactic acid
  • Tretinoin
  • Resorcinol

Most of these are available as OTC products. But it is advisable to have the peeling performed by your dermatologist as the strength and and depth of peeling has to be controlled to obtain optimum results.
Indications: Shallow, soft or superficial macular atrophic scars can be treated with chemical peels.
Caution: Ice pick scars and fibrotic or hypertrophic scars cannot be treated with chemical peels. If not done properly (i.e, using higher strenghths that cause actual burns!), the skin can get burnt and result in more pronounced scars than before. This is a risk that both the dermatologist and the patient has to be aware of.

Acne Scar Removal: Dermabrasion

Dermabrasion is a common treatment employed for most types of acne scars, mainly medium depth acne scars. Dermabrasion, as the name denotes, abrades the superficial layers of skin. This is done, with the help of a brush with a diamond tip or brush that rotates at high speed.
Dermabrasion helps in removing shallow scars and reduce the depth of deep scars.
Microdermabrasion is a process which peels of the superficial skin layers, but this is done with the help of aluminium oxide crystals passed through a vacuum.
Indications:Dermabrasion can reach deeper layers of skin than a chemical peel and hence can be used to treat both deeper and hypertrophic scars. Dermabrasion alone is not advisable for ice pick scars, as removal of superficial layers may result in opening up of the wider base of the scar and the scar may actually look larger than before! A technique whereby, dermabrasion is combined with punch excision of ice pick scar tissue has been found effective by some dermatosurgeons.
Caution: Dermabrasion also, if not done properly, can cause extensive scarring. Dermabrasion is contraindicated in keloidal acne scars, as any stimulation of the dermal layers can result in further keloid formation.

Acne Scar Removal: Exoderm Lift

Exoderm lift is the most extreme form of scar treatment that one can undergo. It is also one that have produced the most dramatic results: very good improvement in some and increased scarring in others!
The procedure is extremely strong and has to be carried out very cautiously. Exoderm Lift is composed of 12 components, including phenol, resorcin, citric acid and a variety of natural oils. The combined effect of these peeling agents has a liquifying effect on the skin, which is later followed by stimulation of new collagen and elastic fibers formation simulating an internal lift of the skin. The new lifted skin looks fresh and young.
Indications: Exoderm lift can be used to treat deep and hypertrophic acne scars.
Caution: Avoid in individuals with keloid tendency. Exoderm lift can produce the same effects as 2 degree or 3 degree burns and hence can cause potential worsening of the acne scars. Hence, it is advisable to test a small area first to asses the results and then go for the full treatment schedule if the results are satisfactory.

Acne Scar Removal: Needle Subcision or Undermining of Acne Scar

This is a technique through which a needle inserted from the side of the scar is swept to the sides to severe the scar bands. Scar bands thus broken allow small collection of blood (hematoma) to form beneath the skin. After a few days the hematoma is absorbed and the scar surface is elevated.
Indications: Needle subcision is particularly effective is small pitted acne scars where is lesser amount of fibrous tissue. Particularly useful for closely placed scars. Chemical peeling following subcision gives better results
Caution: If the fibrous tissue is thick and extensive beneath, subcision method will not work. The results are not always satisfactory.

Acne Scar Removal:  Scar Revision

Each acne scar is approached on its own merit and surgical scar correction (known as acne scar revision) is performed.
The following are some of the common acne scar revision methods employed by dermatologists and cosmetic surgeons:

  • Local Undermining or Subcutaneous Incisionless (Subcison) surgery. (See above) 
  • Punch Excision and Closure   
  • Punch Incision and Elevation(Punch Float)   
  • Punch Excision and Graft Replacement

Ask your dermatologist for the most suitable procedure for your scar.

Indications:

  • Small Pitted Scars 1-2 mm: Subcision
  • Depressed scars up to 2 mm diameter: Punch excision and closure
  • Depressed scars 2-5 mm with normal skin texture: Punch float.
  • Depressed, pitted scars up to 4.5 mm:Punch Excision and grafting

Caution: Hematoma formation, infection, graft rejection, allergic reactions to dressing and scarring may occur following these procedures. In punch excision and grafting, cobble stone appearance when the graft heals is a real problem. Some amount of color discrepancy is also present at the graft site.

Acne Scar Removal: Laser Scar Treatment: Laser ablation, laser resurfacing

Laser scar treatment, though introduced recently is fast picking up as an effective option to treat acne scars. Its effectiveness varies from patient to patient.

Indications: The energy and tissue penetrating capability of lasers are put into use in treating scars.

NdYAG laser, with its deep penetrating ability is used to treat deep irregular scarring.

The infrared beam produced by carbon dioxide laser helps in tightening the collagen fibres in the dermis and help in elevating depressed scars.

Caution: The laser treatment is quite expensive. The side effects are scarring, pigmentary and texture changes in the skin and infection.

Acne Scar Removal: Cryoslush & Cryopeel

This is a comparatively simple and safe office procedure. Application of cryoslush (CO2) produces an immediate lowering of the applied skin to -20˚C. This results in superficial peeling and subsequent remodelling of the skin.
Indications: When combined with subcision, cryoslush or cryopeel is very effective in treating depressed, bound down acne scars and depressed and distensible acne scars.
Caution: Hematoma, infection, color changes and keloid formation in predisposed individuals.

Acne Scar Removal: Soft Tissue Augmentation: Fillers

Soft tissue augmentation means filling the defect in the dermis through infiltration of certain substances known as fillers. This will correct atrophic scars. Previously collagen or fat from another part of body were injected beneath the scar to raise the skin to the surface level. Now a days many artificial fillers are available.

There are many types of injectables used for augmentation. It has been shown that once they are injected into the skin, they can raise the surface of the scar. 
The disadvantage of soft tissue augmentation is that it has to be repeated every 6-10 months’ intervals.

Acne Scar Removal: Intra-lesional Steroid Injections
For hypertrophic and keloid scars, injection of intra-lesional steroids followed by laser ablation is beneficial.

Acne Scar Removal: Excisional Surgery

Excision with or without a punch can be useful in shallow and medium depth acne scars.

Acne Scar Removal: Related Articles

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available for diagnosis and treatment of common skin, hair and nail diseases. No diagnosis should be made or treatment undertaken without first consulting your dermatologist. If you do so, the author will not be responsible for any consequences. The images provided are for illustration purpose only and should not be reproduced without the consent of the author.

About the Author of Skin Care Tips from Dermatologist: Dr Hanish Babu, MD
Dr Hanish Babu, MD, Dermatologist, Sharjah and Ajman, UAE
Dr Hanish Babu, MD

Dr Hanish Babu, MD is a dermatologist with more than 3 decades of experience in treating skin and sexually transmitted diseases in UAE and India. He has been practicing in UAE since last 22 years. He is a respected speaker during the Continuing Medical education Programmes for doctors, medical students and paramedical staff and is also a Stress Management Trainer. He organises group therapy sessions for patients with psoriasis, eczema and vitiligo.

He is available for consultation at Cosmolaser Medical Centre in Samnan, Sharjah (06 5678 200) from 9 am – 1 pm and at City Medical Centre, Al Bustan, Ajman (06-7 441 882) from 4.30 pm – 9.30 pm.

Visit his personal website  dr-hanishbabu.com for more details and for educational articles on Skin, hair, nail and sexually transmitted diseases. Click here to Book an Appointment with dermatologist Dr Hanish Babu, MD