Acne scarring is the result of the body defending itself against the inflammation in the skin cause by clogged skin pores, excess oil production and bacteria. Some people are more prone to acne scars than others, and even superficial inflammation may cause scars. However, according to the American Academy of Dermatology, severe scarring is usually caused by nodulocystic acne --- acne that forms deep under the skin. "Ice pick" scars, which present as jagged, deep impressions in the skin, are the most difficult to treat.
Dermabrasion is considered one of the most effective ways to reduce most acne scars. This can be an uncomfortable procedure for patients, so dermatologists use a local anesthetic to reduce discomfort. The skin is resurfaced with a hand-held device that uses rapidly-rotating wire brushes. Dermabrasion reduces the appearance of most scars, but deeper scars, mainly "ice pick" scars, may become more noticeable. A gentler form of skin resurfacing is a technique called microdermabrasion, which blasts aluminum oxide crystals onto the skin and removes them through a vacuum. However, many microdermabrasion treatments are required for patients to note a difference, and often results are very subtle.
Laser and Light Treatments
Laser treatments can be helpful in reducing scar tissue and eliminating discoloration around healed acne lesions. Lasers vary in wavelength and intensity. Treatment using a carbon dioxide laser, which removes scar tissue, may only be needed once for patients to see good results. However, after the treatment, patients may note redness for months. Nonablative lasers, pulsed light therapy, and radio frequency devices are less injurious to the skin's surface, and patients recover from these treatments more quickly. Multiple treatments may be required before a patient notices any reducing in acne scarring, and as with microdermabrasion, results may be subtle.
Acne scars may be treated individually by injection of collagen or autologous fat transfer (fat taken from another part of the patient's body). These treatments can fill out deeper scars, particularly those caused by cystic acne, however, they are only a temporary fix for acne scarring. Collagen injections last from between three and six months, and autologous fat transfer lasts anywhere from six to 18 months.
Difficult-to-treat scars, such as "ice pick" acne scars, can be addressed individually through a surgical procedure called "punch excision." Each scar is surgically excised down to the subcutaneous fat, after which the resulting hole is either sutured or grafted with skin.