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Treatments to Get Rid of Acne Scars

Scars from past cystic acne can diminish self-confidence. It is often a very frustrating problem for people because a single treatment does not create the results they want. It’s important for you to understand that acne scars can be treated to achieve the best possible results for you by customizing different treatment options. You need to feel comfortable with your understanding of the types of scars you have and what you can expect with treatment.

types of acne scars illustration
Acne scars on female right cheek
ACNE SCARS CAN SAP SELF-CONFIDENCE, BUT TREATMENT IS POSSIBLE WITH A LITTLE COMMITMENT AND PATIENCE.

What Causes Acne Scars?

Acne scars are due to loss of skin and soft tissue from past cystic acne. Tissue loss can range from the loss of surface skin (epidermis) in mild scarring, to deeper loss of the backbone of the skin (dermis) and the tissue under the skin (fat). Enlarged pores can also contribute to the depth and extensiveness of acne scarring. Active acne treatment can dry the skin of oil and moisture, and affect the integrity of skin which can also contribute to the severity of scarring and general loss of skin health.

acne scars causes illustration
PAST OR CURRENT ACNE PROBLEMS CAN CAUSE DIFFERENT KINDS OF SCARS, SUCH AS: DISCOLORED RED MARKS, PIGMENTATION, TO PITTING (ICE PICK SCARS, BOXCAR SCARS, ROLLING SCARS)

The Importance of a Treatment Plan

Acne scar treatment is generally not a single procedure. There is no single definitive method that works for all people. The first step of acne scar treatment is proper diagnosis. Dr. Prasad will take special photos using a method called “back lighting” to show you the levels of the scars and he will educate you about the types of scars you have. After you are informed about the types of scars you have, Dr. Prasad will develop a customized acne scars treatment plan. It’s not unusual for people suffering from acne scars to want immediate results. Unfortunately, this is not realistic and over aggressive treatment can actually lead to damaging your skin further. We’ve observed that frustration from acne scar treatment often leads people to change doctors or even go to a practitioner with limited knowledge and experience who then uses a device such as a laser in a way that is ineffective or worse, damaging.

The basic strategy of acne scar treatment is to treat, wait to allow for healing and recovery, assess the results, and then treat based on the results. This is clinical medicine and is why Dr. Prasad continues to make assessments to guide you toward an optimal result.

Acne Scar Treatments

Acne scar treatment is not a “one size fits all” treatment that works the same on everyone. Factors that contribute to determining the right individual treatment plan include: skin color (amount of pigment), skin type, depth of scars, age of scars, age of the patient, current skin quality and skin thickness, patient age, gender, and past treatments used.

What is the best treatment for acne scars?

Acne scar management requires proper evaluation and clear communication about expected outcomes

and long term strategy it’s very important to understand that one

strategy for acne scars doesn’t apply to everybody and it’s not usually a single

one off process where we do one thing and then you’re done when you seek

opinions from doctors regarding acne scar treatment keep in mind that you

will get different opinions because there is more than one way to approach

these issues practitioners make recommendations based on a perspective

of experience and often whatever is the latest branded device they’re currently

leasing I’ll discuss the steps I take in evaluating a patient with acne scars and

how I make my recommendations and set expectations

I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon and

Fellowship-trained oculofacial plastic and reconstructive surgeon I’ve been in

practice in Manhattan and Long Island for over 20 years I perform a wide range

of procedures for patients with acne scars including lasers use of

radiofrequency technology skin boosting regenerative medicine technology such as

PRP or platelet-rich plasma and a cellular matrix as well as acne surgery

such as subcision scar removal and skin grafting when I look at a patient with

acne scarring I take high-resolution digital photos

and I also take photos with the method called backlighting to look at the

shadows which provide me with information about the depth and extent

of the scars acne scars are typically classified as rolling scars Boxcar scars

and ice pick scars there are different levels of all these

scarring and a strategies developed based on these specific classifications

when you’re dealing with acne scars you are dealing with one common issue tissue

loss the underlying strategy is to maximize the volume where tissue is

deficient and to blend the interface between the normal skin and the adjacent

area of tissue loss unfortunately many people with acne scars literally jump

from one laser to another based on aggressive marketing resulting in

frustration and disappointment a very important limitation is the generally

accepted standard amongst ethical professionals as to the maximum level of

change that can occur with acne scars generally speaking improvement of about

20 percent followed by maintenance procedures is a realistic expectation of

course the term twenty percent can be up for subjective interpretation for my

patients I find that defining success as an improvement avoids unrealistic

expectations my approach to acne scars is comparable to my approach with facial

aging I create a customized strategy to work from the inside outward for example

if the cheek volume can be enhanced I will place a long-lasting filler such as

Juvederm Ultra Plus or Juvederm Voluma at the bone level the improvement in

projection can have a significant effect on softening the appearance of acne

scars this becomes particularly relevant with the natural progression of facial

aging I also see how improvement in volume and facial balance can shift

focus away from the acne scars at the skin level although it is commonly

accepted that various lasers can help depress cars by controlled injury which

then stimulates a healing response by cells

in the skin called fibroblasts to produce collagen the question is how

much of a difference can be achieved when the tissue is scarred in addition

how much collagen generation can occur when the patient has had one or more

previous laser radiofrequency or micro needling procedures

I find myself consistently integrating the use of PRP or

platelet-rich plasma to induce collagen production without causing any

significant injury as a first-line before or in conjunction with non

ablative laser treatment PRP or platelet-rich plasma not only stimulates

collagen production but also improves blood supply and softens the scar tissue

in particular for patients with Boxcar scars I find this strategy useful I

routinely combine PRP with hyaluronic acid filler which is delivered to the

dermis using a procedure called skin boosting rolling scars and scars

associated with the lack of underlying fat are often managed through a

combination approach procedures such as subcision injectable fillers are placed

on the bone level below the skin and in the dermis that combination can be very

effective there is also a type of ablative laser technology often

beneficial particularly for Boxcar scars these are scars with very sharp defined

edges generally when using a laser we try to soften the edges of these scars

and then blend the skin so that the skin heals smoothly for improvement

another approach which is more convenient and beneficial particularly

for shallow scars is water-based microdermabrasion or a procedure that

has called HydraFacial there is no downtime and the improvement in the skin

can be appreciated immediately afterwards I recommend that any

therapeutic strategy for acne scar involve regular follow-up examinations

and some maintenance procedures which are customized to the individual in a

time where devices get aggressively marketed and unrealistic expectations

are promoted it’s more important than ever for you to find a physician who you

trust to have your best interest at heart all

too often new devices come on the scene and many doctors buy or lease these

devices and then think only about the profit from the transaction and have no

interest in a long-term management plan I recommend you meet with experienced

doctors and make sure you feel that you are being well informed and you have

confidence in the doctors treatment plan for you and what the short-term and

long-term outlook will be

I hope you found this information helpful thank you for your question

Acne scar treatments range from:

  • laser skin tightening
  • laser resurfacing
  • chemical peels
  • microdermabrasion or HydraFacial for surface skin renewal
  • subcision (surgical release of scars)
  • platelet-rich plasma for collagen generation and skin quality improvement
  • microneedling
  • cosmetic fillers to fill deep scars.

Depending on the individual, a combination of some to all of these treatments may be needed in various amounts and aggressiveness.

Subcision to Release Deep Acne Scars

Subcision is the process of releasing acne scar tissue from the dermis. This involves using a special blunt cannula-type tool, or a special needle to go underneath the skin to release scar tissue directly underneath the scar. Subcision is used for deep pitted, rolling acne scars where the surface of the scar is tethered to deeper scar tissue at the dermis. Once the surface scar is released from the deeper scar tissue at the dermis, the depth of the scar is reduced. However, because of the previous loss of tissue, volume augmentation is generally needed to fill the area where tissue was lost causing the depressed scar.

subcision procedure for acne scars illustration
RELEASING TETHERED ACNE SCARS FROM SCAR TISSUE WITH THE PROCESS OF SUBCISION. WHEN THE TETHERS ARE RELEASED IN THE DERMAL LAYER, DEPTH OF THE ACNE SCAR IS GREATLY REDUCED

Dermal Fillers for Deep Acne Scar

With subcision release of the scar, there is still a volume deficit from previous tissue loss. Volume augmentation is needed to support the skin and fill the depth left from lost facial tissue from acne scars. Injectable cosmetic fillers such as Restylane or Juvederm are applied in specific amounts in the dermal and subdermal layer to improve scar depth.

acne scars PRP treatment before and after, procedure done at Prasad Cosmetic Surgery NYC
acne scars PRP treatment before and after, procedure done at Prasad Cosmetic Surgery NYC
DERMAL FILLERS SUCH AS RESTYLANE OR JUVEDERM CAN FILL DEEP ACNE SCARS DUE TO LOSS OF SKIN, DERMIS, FAT, AND OTHER TISSUE.

Subcision can actually be performed simultaneously as a filler application. In this situation, the needle of the filler syringe is used as a subcision tool to release the scar tissue, followed by the filler placed in the pitted area.

Fillers can treat specific acne scars such as atrophic scars (sunken or deep pitted scars due to collagen destruction) and tethered scars (attached to deeper dermis and requires subcision). Lasers can improve skin quality and tautness, but generating collagen with lasers will not do much for very deep scars compared to fillers.

One of the best advantages of using fillers for acne scars is the fact they can improve the appearance of scars immediately, and with virtually no downtime. Fillers cannot treat every type of scar. Fillers are often used in combination with other treatments, such as lasers, PRP, and TCA peels. There may be differing recovery times based on the type of treatment. Fat grafting can also be used in areas with thicker skin such as the cheeks. Fat grafting requires harvesting of fat with liposuction and placement with some recovery time. One significant challenge with fat is predictability of result. 30-70% of fat can be absorbed and it is typical to need more than one procedure for maximal benefit.

Platelet-Rich Plasma (PRP) Treatment for Acne Scars

Platelet rich plasma also referred to as “PRP” is a concentration of healing factors from your own blood to stimulate your body to produce collagen, increased blood supply as well as improvement and increase in the fat cells seen with healthy skin. Platelet-rich plasma (PRP) can be used in combination with other acne scar treatments. For example, microneedling with a device such as a Dermapen, tiny channels are created through the skin, PRP can be applied on the skin surface to allow it to pass through to the deeper layers. PRP can also be injected directly beneath the skin. PRP can also be used in conjunction with cosmetic fillers to improve skin quality, and provide volume for deep scars.

before and after prp treatment for acne scars - female right cheek
PLATELET-RICH PLASMA (PRP) CAN IMPROVE COMPROMISED SKIN QUALITY FROM PAST ACNE, AND INCREASE COLLAGEN AND BLOOD SUPPLY TO THE AFFECTED AREA TO TREAT RED ACNE SCARS. THE COMBINATION WITH A HYALURONIC ACID COSMETIC FILLER IMPROVES SCAR DEPTH, AND PRP INCREASES LONGEVITY OF THE FILLER
before and after prp treatment for acne scars - female right cheek
PLATELET-RICH PLASMA (PRP) CAN IMPROVE COMPROMISED SKIN QUALITY FROM PAST ACNE, AND INCREASE COLLAGEN AND BLOOD SUPPLY TO THE AFFECTED AREA TO TREAT RED ACNE SCARS. THE COMBINATION WITH A HYALURONIC ACID COSMETIC FILLER IMPROVES SCAR DEPTH, AND PRP INCREASES LONGEVITY OF THE FILLER

PRP is also used as a topical healing agent after laser skin resurfacing for acne treatment. When injected directly to specific areas, PRP helps improve the volume blood supply and healing proteins such collagen. PRP helps tissue healing as well as pigmentation caused by scarring or trauma.

Laser Treatment for Acne Scars

Laser resurfacing is frequently used for acne scar treatment when the scars are relatively the same depth, such as shallower scars or boxcar scars. Lasers are used to level scars through partial or full ablation of the top layers of skin to allow for a fresh, smooth layer of skin to come in. 

The heat of the laser also stimulates an injury response within the deeper layer of skin (dermis) to produce collagen. It is the loss or destruction of collagen in the dermis that results in the scars. Producing new collagen in the injury response to heat treat improves the overall quality of the skin within and around the scar.

Non-Ablative/ Fractional Laser Treatment for Different Skin Types

Laser treatments can be widely used in lighter skin types,. In darker skin however, these types of laser may cause hyperpigmentation (skin darkening) or hypopigmentation (loss of skin pigment) so application of these lasers must be done cautiously or not at all.

Lasers are often used for acne scars which are shallow to medium depth where the depths of the scars are at about the same level, such as is often seen in boxcar scars. Deeper scars don’t respond in the same way to laser resurfacing because it is too unsafe to resurface the skin to the depth of deep scars. Deep scars are best treated with subcision, acne scar surgery, or TCA cross (in the case of icepick scars).

Most lasers can be used safely for lighter skin types, but it is important that the right laser or combination of lasers be used to get the most optimal result. For lighter skin types, we use fractional erbium and CO2 laser as well as ND:Yag, and Q Switch lasers.
For darker skin types from Mediterranean, olive skin, to Asian skin types, we use ND:Yag, Erbium, and Q Switch lasers, as well as radiofrequency devices such as Pelleve for more gentle heating.

fractional laser before and after acne scars
NON-ABLATIVE LASER ACNE SCAR TREATMENT TAKES SEVERAL SESSIONS, BUT RECOVERY TIME IN BETWEEN SESSIONS IS REDUCED, WITH ONLY MILD SKIN DISCOLORATION DURING HEALING, UNLIKE THE HEAVY DISCOLORATION OF FULLY ABLATIVE LASER TREATMENT
fractional laser before and after acne scars
NON-ABLATIVE LASER ACNE SCAR TREATMENT TAKES SEVERAL SESSIONS, BUT RECOVERY TIME IN BETWEEN SESSIONS IS REDUCED, WITH ONLY MILD SKIN DISCOLORATION DURING HEALING, UNLIKE THE HEAVY DISCOLORATION OF FULLY ABLATIVE LASER TREATMENT

For even darker skin types such as African or Arabian skin, we approach these on a case-to-case basis. Some darker skinned people may react to laser treatment with hyperpigmentation of the skin, as well as scarring, so in some cases no laser or thermal energy treatments can be used. In such cases, we treat acne scars with options such as chemical peels to resurface the skin, platelet-rich plasma (PRP) for skin improvement, and cosmetic fillers.

Acne Discoloration Removal

Some acne scarring does not involve deep pitted or depressed scars, but rather skin discolorations such as red or brown spots. These spots can be treated with less aggressive laser protocols like the 1064 YAG or the Q switch QX Max with minimal downtime. Platelet-rich plasma can also be used to treat dark spots by helping heal the scarred area and increasing collagen and blood circulation into the localized spot.

before and after laser treatment for acne scars - female left side view
ACNE SCARS IN THE FORM OF RED MARKS CAN BE TREATED WITH A LASER, BUT THE TYPE OF LASER USED WOULD DEPEND ON ETHNICITY AND SKIN TYPE

Fully Ablative Laser Treatment for Acne Scarring

Fully ablative CO2 and Erbium lasers were the standard for acne scar laser treatment before the introduction of fractional lasers. Full ablation is an aggressive technique that completely removes, or ablates, the top layer of skin (epidermis and dermis) so a new layer can grow in, and triggers a collagen response in the backbone of the skin (dermis) as a response to the injury. The fully exposed dermis leaves the skin with a very raw appearance, which can appear anywhere from dark pink, red, or even light brown. This red and raw appearance is the biggest drawback of fully ablative laser treatment as downtime can be extensive – patients have to avoid being outside for the first week because of potential side effects from sun exposure to the raw skin. The raw appearance can last for over a week, making fully ablative laser resurfacing less popular for busy, working people.

The advantages of fully ablative laser resurfacing are the level of results and long term benefit. There is no need for a series of treatment sessions. The fully ablative procedure only requires one treatment session, followed by longer downtime when compared to a non-ablative or partially ablative procedure that has little to no downtime, but requires multiple treatment sessions. It can be argued that the results of a fully ablative procedure are better and more thorough, but multiple non-ablative procedures can achieve comparable results.

Why are skin treatments not improving my acne scars?
Unfortunately it’s very common for people with acne scars to be frustrated with their acne scar treatments
I see patients who’ve been treated with multiple devices ranging from different lasers as well as
radio frequency and micro needling devices
patients also report having undergone chemical peels or platelet-rich plasma or PRP injections
and just not seeing the results that they were expecting I’ll share some of my experience helping
my patients who have acne scars I’m Dr. Amiya Prasad I’m a Board-certified cosmetic surgeon
and Fellowship-trained oculofacial plastic and reconstructive surgeon been practicing in New York
City and Long Island for over 25 years I routinely help people with acne scars using specific
lasers and radiofrequency devices I perform acne scar surgery such as subcision for tethered scars
I also have a lot of experience with PRP to improve skin quality texture and hyperpigmentation
these treatments mentioned can improve the appearance of acne scars because
they improve skin quality the skin texture and can even tighten and resurface the skin however
there is a major aspect of acne scars that these treatments cannot address especially the deeper
acne scars where there is deeper tissue loss acne scars are primarily the result of inflammation
inflammation can leave the skin architecture to be fragmented disorganized and leading to tissue
loss at the skin level and deeper the treatment of deeper acne scars may involve some form of
restructuring and restoration for example i perform a procedure to release the tethering
of the skin with the underlying tissue and the procedure is called subcision during subcision
different instruments are placed under the skin to release scar tissue that’s responsible for
pulling the skin inward subcision also stimulates collagen production as part of the body’s natural
healing response after the procedure subcision is generally performed for rolling type scars
after subcision for a rolling scar a hyaluronic acid filler can be placed
underneath the skin to support the skin for a smoother appearance
boxcar scars are more limited to the skin level and have defined edges they are also generally not
as wide as rolling scars I often use combination treatments to help people with boxcar scars
and for example I’ll perform a non-ablative laser for dermal tissue remodeling and use
hyaluronic acid with PRP to optimize volume and collagen production within the skin speaking
of hyaluronic acid an area that is frequently overlooked is volume deficiency below the skin
this volume deficiency can be due to bone projection fat volume or a combination of the two
I’ve had a lot of patients who for all intents and purposes came in to see me after they underwent as
much skin focused treatments as could ever be performed I recognized that for many of
these patients volume support below the skin can create projection and smoothening of this
acne scars fairly effectively so as opposed to placing the filler just below the acne scars
I often place the filler at the bone level with a specific technique called structural volumizing
now this technique allows more stable support of the skin from the bone level many of these
patients have been delighted by the results which they can appreciate immediately afterwards
aggressive marketing of devices in my opinion is why many people are frustrated after not seeing
benefit after one treatment this frustration causes many people to go from one practitioner to
another all of whom who claim to have the latest and greatest device unfortunately these patients
often end up damaging their skin even further recognizing that there are different types of
acne scars skin color and skin types so that there is no one best treatment that applies to everyone
with several modalities and techniques available to use for treating acne scars I generally take
a fairly conservative approach what I frequently do is to treat observe the results and customize
future treatments accordingly in my opinion rather than being manipulated by aggressive marketing
focused on financial transaction it’s better for you to identify a physician who can provide you
with the treatment plan and realistic expectation of results I hope this information from my
experience helped you
If you are interested in recommendations for your individual situation
you may contact us through our websites or call our offices to schedule a consultation thank you

TCA Peels and TCA Cross

Trichloroacetic acid (TCA) is a non-toxic chemical that is related to vinegar. TCA peels have long been the standard of skin resurfacing before the advent of laser technology and laser resurfacing. A TCA peel can be used for renewing the outer surface of the skin (epidermis) with the same principles of fully ablative to partially ablative treatment as lasers. The treatment depth of a TCA peel depends on the concentration of TCA, which can range from 15% to 50%. Also, manipulating the TCA solution by the extent of rubbing or placement on the skin can also affect the depth of the treatment.

The TCA cross is a unique way of treating deep acne scars. A tiny amount of high concentration TCA is placed directly onto medium depth acne scars. The TCA cross leaves a white spot on the treated area for about 3 hours, while redness of the skin lasts about 5-7 days. This process raises the depth of acne scars, making it an effective option for deeper acne scars, but it still needs additional cosmetic filler to support the raised scar.

TCA can be used, but in different treatment techniques, from more uniform acne scarring at shallower depths with a TCA peel, to deeper scars with a TCA cross.

Acne Scar Surgery for Linear Acne Scars

Linear acne scars, or longer acne scars, tend to be a more severe form of acne scarring due to being longer and larger. The treatment of larger scars include a combination of the previously mentioned acne scar treatments, but also involve surgical closure of the scar. When dealing with bigger linear scars, it is important to choose a doctor based on surgical skill and the prevention of forming bigger scars. Cosmetic surgeons are chosen for acne scar surgery because of their extensive experience in surgical closure to maximize the cosmetic results.

Reviews on Acne Scar Treatment

I have very bad acne scars on my face. I’ve done everything to remove for the past 20 yrs. After 2 months of ‘y lift’ I noticed a positive side effect on my acne scars. Reviewer: bookfashion
Patient review: Extremely pleased with Dr. Prasad! He is truly the best

Schedule Your Manhattan, NYC or Garden City, Long Island Acne Scar Treatment

Contact us today for an evaluation of your acne scarring by Dr. Prasad. He will develop a customized treatment plan for you.

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