Acne Scarring

Acne scars vary in shape, depth, and severity, and understanding these differences helps in determining the most effective treatment approach. The main types of acne scars include:

1. Atrophic Scars: Often caused by a loss of collagen, these scars create depressions or indentations in the skin. They are typically subdivided into ice pick scars (deep and narrow), boxcar scars (broad with defined edges), and rolling scars (wavy and shallow).
2. Hypertrophic and Keloid Scars: Unlike atrophic scars, hypertrophic and keloid scars result from an overproduction of collagen. These scars often form as raised, firm areas above the skin surface, especially on the chest, back, or shoulders.
3. Post-Inflammatory Hyperpigmentation (PIH): While technically not a scar, PIH appears as dark spots following acne lesions, particularly in individuals with darker skin tones. It can take months or even years to fade without treatment.

Acne scars form when acne lesions, such as cysts, pustules, or papules, damage the underlying skin layers. When the skin tries to heal, it can either produce too little or too much collagen, resulting in atrophic or hypertrophic scarring. Factors that increase the risk of scarring include:

• Severity of Acne: Deep, inflamed lesions like cystic acne are more likely to leave scars.
• Delay in Treatment: Prolonged inflammation from untreated acne can cause more skin damage.
• Skin Picking or Squeezing: Manipulating acne lesions disrupts the healing process, increasing the likelihood of scars.
• Genetics: Some individuals are genetically predisposed to scarring.

Treating acne scars requires a personalized approach, as each scar type responds differently to various treatments. Palo Alto Dermatology Institute offers several advanced therapies to help patients achieve optimal results:

1. Laser Resurfacing: Laser treatments like Fraxel repair, a fractional CO2 laser, and UltraPulse CO2 laser can help stimulate collagen production and resurface the skin, improving the appearance of atrophic scars and reducing PIH. These lasers are highly effective for patients with lighter skin tones and minimal to moderate scarring.
2. Microneedling: Microneedling uses tiny needles to create controlled micro-injuries in the skin, prompting the skin to repair itself by producing collagen and elastin. This treatment is effective for various acne scars and is safe for all skin types.
3. Chemical Peels: Chemical peels use acid solutions to exfoliate the top layers of the skin, reducing PIH and superficial scars. Deeper peels may also improve the appearance of moderate atrophic scars. A dermatology specialist at Palo Alto Dermatology Institute will customize the peel strength based on the patient’s skin type and scar severity.
4. Dermal Fillers: For deep, indented scars like boxcar and rolling scars, dermal fillers can add volume to the skin, creating a more even texture. These fillers offer immediate results, though they may require periodic maintenance.
5. Subcision: This minimally invasive procedure targets tethered scars by breaking up the fibrous bands beneath the skin that cause rolling scars. Subcision can be used to treat one scar as many as 80 scars. Subcision can be combined with other treatments, such as microneedling or fillers, for enhanced results.
6. Topical Treatments and Skincare Regimens: Custom skincare regimens that include retinoids, antioxidants, and brightening agents can reduce PIH and improve skin texture over time. Palo Alto Dermatology Institute’s dermatologists provide patients with personalized skincare plans that support in-office treatments for long-term improvement.

Each patient’s skin and scarring are unique, which is why Palo Alto Dermatology Institute emphasizes an individualized treatment approach. Their dermatologists work closely with patients to assess skin type, scarring severity, and overall skin goals, developing a comprehensive treatment plan. The combination of in-office procedures with tailored at-home care maximizes results, improving skin appearance and texture over time.

By addressing acne scarring with advanced techniques and personalized care, Palo Alto Dermatology Institute helps patients move beyond the impacts of past acne, allowing them to enjoy a more even, healthy complexion.