Acne Scar Treatment: Modern Approaches
Acne scarring affects skin texture and confidence long after active acne resolves. Contemporary treatments can significantly improve even severe scarring, though realistic expectations and commitment to treatment are essential.
Understanding Scar Types
Atrophic Scars
These depressed scars result from collagen loss during healing. Ice pick scars are narrow and deep, resembling puncture wounds. Boxcar scars have sharp, defined edges and flat bases. Rolling scars create an undulating texture from fibrous bands tethering skin to deeper structures.
Each type requires different treatment approaches. Ice pick scars may need TCA CROSS (chemical reconstruction) or punch excision. Boxcar scars respond to resurfacing procedures. Rolling scars benefit from subcision to release tethering.
Hypertrophic and Keloid Scars
Raised scars from excessive collagen production require different strategies. Intralesional steroids flatten raised areas. Pulsed dye laser reduces redness. Silicone sheets or gels may help prevent recurrence after treatment.
Modern Treatment Modalities
Fractional Laser Resurfacing
Fractional CO2 and erbium lasers create controlled thermal injury, stimulating collagen remodelling. Modern devices allow customisation of depth, density, and energy based on scar severity. Multiple sessions progressively improve texture.
Recovery involves 5-7 days of redness and peeling. Results continue improving for 3-6 months as collagen remodels. Most patients require 3-5 sessions for optimal improvement.
Radiofrequency Microneedling
Combining mechanical and thermal injury enhances results beyond standard microneedling. The insulated needles deliver energy at specific depths, sparing the epidermis and reducing downtime. This makes it suitable for darker skin types at higher risk of post-inflammatory hyperpigmentation.
Chemical Reconstruction
TCA CROSS involves applying high-concentration trichloroacetic acid focally to scar bases. This creates controlled injury, stimulating collagen production from the scar's deepest point. The technique particularly suits ice pick and small boxcar scars.
Combination Approaches
Optimal results often require multiple modalities. Subcision releases tethered scars, fractional laser resurfaces texture, and filler or fat grafting restores volume. This comprehensive approach addresses all aspects of scarring.
Treatment Planning
Successful scar revision requires realistic expectations. Improvement of 50-70% is typical; complete elimination is rare. Deeper scars and those present for many years respond less dramatically than recent, superficial scarring.
Skin type influences treatment selection. Darker skin requires conservative approaches to avoid pigmentation changes. Pre-treatment with hydroquinone or tretinoin may optimise results and reduce complications.
The Treatment Journey
Initial consultation should include detailed assessment using standardised photography and possibly 3D imaging. This documents baseline appearance and tracks improvement. Discussion should cover expected outcomes, number of sessions, and associated downtime.
Most protocols involve treatments every 4-8 weeks. Aggressive treatments require longer intervals for complete healing. Patience is essential - final results may not be apparent for 6-12 months after treatment completion.
Maintenance and Prevention
Preventing new scarring during treatment is crucial. This may require oral isotretinoin or other acne medications. Sun protection prevents pigmentation changes that can emphasise textural irregularities.
Post-treatment skincare optimises results. Retinoids stimulate ongoing collagen production. Vitamin C provides antioxidant protection and supports collagen synthesis. Regular gentle exfoliation maintains improved texture.
Ready to address acne scarring? Schedule your free WhatsApp consultation. Send clear photos of your scarring for honest assessment and personalised treatment recommendations.