Unwanted scars can be a devastating result of cystic acne, leaving one with a dimpled, irregular skin surface. Avoiding these scars before they occur is the most desirable course of action, but sometimes it is too late. Treatments can alleviate the visibility of these irregularities. The specific treatment options vary and should target the type of scar present. Sometimes a combination of scar types are seen on an individual.
A key point is to realize that acne scar treatments do not often eliminate acne scars, they can reduce their visibility. Reduced shadowing and scar depth is the goal of treatment, but signs of the scars are often still seen. In certain cases, the skin can look exceptionally smooth after treatment, but this is not true for all patients.
Above is a diagram of acne scar types. The deepest, ice-pick scars are the most difficult to treat. Chemical peels (using the CROSS method with TCA) and laser resurfacing may be of the most benefit in ice-pick scars. Other techniques for deep scars include skin punches and floating punch grafts.
Box-car and rolling scar types often respond better than ice-pick scars. These are best treated with laser resurfacing and dermal fillers. The Fraxel laser has an excellent track record when it comes to acne scarring. Fraxel Restore uses fractional photothermolysis with an erbium laser to build collagen in the dermis. Fractional CO2 lasers such as ActiveFX and DeepFX and Fraxel Repair are also excellent for these types of acne scars. Fillers used to improve acne scars include hyaluronic acid (HA) products (Juvederm, Restylane, Perlane). In Michigan, HA fillers are the most popular form of wrinkle and injectable acne scar treatments, especially when performed in conjunction with laser resurfacing.