Acne Scar Removal

Deep acne scars, such as the 'ice pick' variety, may require several procedures or a few different types of therapy for great results. Even light acne scarring may take more than one chemical peel or several weeks and months of at home treatments.

What Is Acne Scar Removal?

Acne Scar Removal is the treatment or surgical procedure to help fade or remove or improve various degrees of acne scarring with lasers, chemicals, topical medications, manual abrasion or excision. Some procedures may involve filling the depressions with various fillers and products such as:

topical medications
autologous (your own) fat
bovine (cow) collagen
porcine (pig) collagen
cultured human collagen
hyaluronic acid
synthetics such as polymethylmethacrylate (PMMA) products such as Artefill (Artecoll)
Sculptra (NewFill; a poly-lactic acid catalyst)
plus many more, please see our injectable fillers section for more information.

Some treatments are followed up at home with topical medications and chemicals, others which are strictly in-office procedures with a good amount of post-operative healing (downtime) involved.

Acne lesions may leave lasting remnants which are often the bane of many a person's existence. Some problems may include the most common, hyperpigmentation or post inflammatory hyperpigmentation (PIH). This type of hyperpigmentation is when the acne lesion results in a darkened area of skin which may be red, brown, tan or black, depending upon your skin tone. The most common being a reddish color in persons of European decent and a darker brown in persons from ethnic heritages. Actually, this is normal and will eventually subside on its own but may take a considerable amount of time in many patients especially if your skin's natural turnover rate is very slow. The process can be sped up with the use of manual exfoliation, melanin production-inhibiting medications such as hydroquinone, or chemical exfoliants such as tretinoin (the active ingredient in Retin A), Vitamin C can help lighten, and Copper Peptides can increase wound healing and promote healthier looking skin.

Hypopigmentation, which may be lightened areas of skin which seem to have lost their pigment. Others may be raised, irregular scars, or medium to deep pock marks. Others may seem pitted or dented in. Each type of lesion or skin irregularity will determine the course of treatment you will need.

Persons with active acne may consider starting a treatment course to treat their acne before embarking on a scar removal procedure. Removing acne scars may possibly thin the skin in some areas so removing scars only to have more surface needing additional removal at a later date may set you back further than you'd like.

What Causes An Acne Scar

Acne scars are usually caused by inflammation at a cellular level, causing darkened (post inflammatory hyperpigmentation, PIH) or lightened pigmented areas, disruption of collagen fibers and an overproduction of scar tissue. However, inflammation which alters the collagen structure can create a pock mark or other unsightly scar. The damage may even affect the melanin production in your skin resulting in a lightened, hypopigmented area. Hypopigmentation is more difficult to correct than hyperpigmentation but there are treatments available.

A anti-inflammatory diet rich in anti-oxidants can decrease break outs, Rosacea and improve skin overall. Try a diet such as The Perricone Prescription and see a difference in less than 28 days. Menu items include salmon, blueberries, tomatoes, and green, leafy vegetables. Some foods to avoid: Sugar, starchy foods such as potatoes, white rice or bread, and caffeine.

Are You a Candidate for Acne Scar Removal?

First and foremost, an individual must be in good health, not have any active diseases or pre-existing, serious medical conditions and must have realistic expectations of the outcome of their procedure. Communication is crucial in reaching one's goals. You must be able to voice your desires to your surgeon if he/she is to understand what your desired results are. Discuss you goals with your surgeon so that you may reach an understanding with what can realistically be achieved.

Having active acne may disrupt your end result or treatment may exacerbate your active acne causing unsightly and problematic flare-ups, therefore additional scarring. It is suggested that you have your acne under control, as much as possible before starting a scar removal process.

Be sure to disclose all past and present medications, if applicable, to your physician or skin care technician. For instance, having been on Accutane may increase your chances of complications such as keloid scarring, skin necrosis (tissue death) and prolonged healing. Even if you have used Accutane 6 months to a year before your procedure is to be performed, it is very wise to let your doctor know.

Your Options for Acne Scar Removal

Options may include home treatments such as topical medications and weak to medium chemical peels, in-office treatments such as microdermabrasion, laser, Intense pulsed light, injections, dermabrasion or dermaplaning. We will outline the available options below, however only a qualified medical professional may be able to determine if any of the described treatments are appropriate for your individual case.

Topical Medications: Topical medications may include tretinoin (the main ingredient in Retin A), hydroquinone, alpha hydroxy acids, vitamin C serums, etc.
Microdermabrasion or Macrodermabrasion:
- Microdermabrasion often uses either aluminum oxide or magnesium oxide crystals with a machine which blasts the stratum corneum (upper most layer) away with positive pressure and also uses negative pressure (suction) to not only suck the crystals back up to decrease mess but also to increase circulation during the procedure.- Macrodermabrasion uses salt to exfoliate the top layer of skin and no negative pressure. Many macrodermabrasion machines also utilize ultrasonic energy as well.
Chemical Peels: Chemical peels may include lactic acid, salicylic acids, trichloroacetic acid (TCA), and others.
Intense Pulsed Light (IPL): IPL treatments involve undergoing exposure to very bright light on the treatment area to remove hyperpigmentations and improve skin's elastin.
Laser Resurfacing: Lasers such as Carbon Dioxide (CO2), Smoothbeam, CoolTouch and others, can assist in improving active acne and acne scarring. This procedure literally involves the lasering off of the top layers of skin. Depending upon the depth of the procedure, there will always be some amount of weeping and redness, with risks of hyper- and hypopigmentation.
Punch Graft: Punch graft treatments are reserved for severe acne scarring, usually not including hyperpigmentations. Punch grafts are more appropriate for ice pick type acne scars which are very deep and experience no improvement after conventional procedures. The process actually removes the acne scar by excision and the wound is sutured closed.
Subcision: Subcision procedures are reserved for acne scars which are dented due to scar tissue bands pulling downwards on the skin. This procedure involves a needle insertion and breaking up the scar from underneath to allow the release of skin. Some scars will require the addition of an injectable filler as well (see below).
Injectable Fillers: Injectable fillers are for scars which are dented and other procedures to not trigger improvement in collagen formation. These fillers, which may be collagen, hyaluronic acid, or synthetic products, are injected into the acne scar both to fill out the area of the dent and to trigger collagen formation. It is advised to go very slow with injectable fillers as your own rate of collagen formation is very different from the next patient and it is always best to under correct than over correct.
Dermabrasion: Dermabrasion can be a harsh procedure and requires considerable down time. Recovery methods have improved however in the form of chitosan masks or hyaluronic gels. This procedure literally involves the sanding off of the top layers of skin. Depending upon the depth of the procedure, there will always be some amount of weeping and redness, with risks of hyper- and hypopigmentation.
Dermaplaning: Dermaplaning is the act of removing layers of skin using a sharp razor like instrument. This can be done on its own or before chemical peels to give deeper penetration of the chemicals.
Skin Lifting: If the scars are shallow, yet numerous, minor face lifting and tightening procedures can assist in lessening the appearance of scarring. If you can slightly tug at your skin to the outside of your face and you notice improvement and you don't have ice pick scarring, you may be a candidate for this if all other treatments have not produced satisfactory results.

What to Expect at Your Consultation

After checking a few doctors' backgrounds and credentials, you will make an appointment for a consultation. You will meet with these doctors and discuss your goals and you will disclose all information regarding your health; if you smoke, what medications or vitamins you presently take, etc. as this is very important. If you smoke, you really should consider smoking cessation as this can significantly decrease healing and general skin health. Visit the Medication & Supplements List for more information on which medications and supplements may be dangerous to your health before and after a procedure.

You will discuss your complaints and concerns and discuss the various techniques, the amount that can be corrected, etc. He or she should discuss the risks associated with acne scar removal with you, as well. If you would like more information on consultations or a list of questions to ask your surgeon please visit the Consultation Help Page. If you should choose to book or reserve a surgery date you will usually give a deposit to hold your surgery date. Most times if you cancel a few days beforehand, this amount is non-refundable. After paying your deposit and scheduling a treatment date, you may also schedule a pre-operative appointment if it is necessary. Usually, more invasive procedures require pre-operative appointments to have lab work prescribed, preparation and recovery instructions reviewed and to answer any last minute questions...

Your Preoperative Appointment

Although not always necessary before acne scar removal procedures, this appointment addresses more questions you may not have thought to ask at the initial consultation, such as more treatment details, concerns and even ascertaining that your surgeon is aware of what you desire from your procedure. Just as your surgeon will make certain that you know what it realistically possible from this procedure.

You will also discuss your pre-treatment instructions and speak about the recovery period instructions and what to expect in the months ahead. You may be given prescriptions for antibiotics, pain relievers, perhaps blood pressure medicines, prescription anti-inflammatory drugs and perhaps Arnica montana. (Read more about Arnica montana now)

Perhaps you will be instructed to obtain multivitamins or supplements such as Bromelain and other types of remedies, although many surgeons would rather have you not take anything other than your prescription medications, please do not go against your surgeon's wishes. Remember, always ask your doctor before taking any of these products.

Please do not hesitate to address any concerns that you may have during this time and even after your pre-treatment appointment. If you remember something when you get home or the next day or even the day of your treatment, don't be afraid to ask.

Preparing for Your Treatment

You should be given a pre-operative information packet that explains everything you should do and know before your procedure date. This may include cessation of certain medications as explained above, skin preparation with topicals such as Retin A or hydroquinone, or a change in diet.

Your preparation depends largely upon your chosen procedure, doctor's protocol and your skin's tolerance. Please discuss your preparation methods with your doctor and adhere to his or her instructions.

How Acne Scar Removal Is Performed

Depending upon the procedure you will be having you may or may not need sedation. We will cover common acne scar removal methods below:

Microdermabrasion or Macrodermabrasion: This procedure does not require sedation and is performed in-office as a "lunch time" procedure. Although you may or may not wish to return to work, you will not have excessive downtime on a typical treatment. Microdermabrasion is a particle exfoliation procedure utilizing aluminum or magnesium oxide crystals in the 90 to 120 grit range. The microdermabrasion machine uses a closed system that exfoliates the skin using a mild to medium blasting mechanism through a negative pressure nozzle. Although the exfoliating medium is blasted onto your skin, the negative pressure sucks the crystals back up so there is little mess. The stratum corneum is removed via particle exfoliation and the light suction on the skin increases circulation curing the procedure. This procedure is designed to be carried out over several consecutive sessions for optimal results. One treatment is usually not sufficient to make a noticeable difference in improvement. For more information, please see our Microdermabrasion Section.
Chemical Peels: There are many types of chemical peels, from home peels using alpha hydroxy acids or low strength trichloroacetic acid (TCA), to high strength TCA and phenol peels. Depending upon the depth it will penetrate and the chemical to be applied you may or may not need sedation. More than likely any TCA peel over 12% will be done in a doctor's, however home peels can be up 25% if you are experienced and have had several lower strengths without ill effect. Without proper skin prepping with lower strengths and topical medications, you can cause irreversible damage in the form of hyper- and hypopigmentation and scarring. Do not attempt medium to high strengths at home unless you are absolutely experienced and your skin is properly prepared. For more information, please see our Chemical Peel Section.
Intense Pulsed Light: Usually no topical anesthesia is required but many patients do prefer an EMLA (ectatic mixture of local anesthetics) beforehand if their doctor allows it. The procedure involves several to many flashes of very intense light which may sting a bit without anesthesia. For more information, please see our Intense Pulsed Light Section.
Laser Resurfacing: Deep laser treatments require anesthesia due to the level of pain which is felt during the procedure For more information, please see our Laser Resurfacing Section.
Nonablative Laser Treatments: For more information, please see our Polaris or NLite sections.
Punch Graft: This requires removing a small, oval piece of skin that contains the scar and sewing the hole closed.
Injectable Fillers: For more information, please see our Injectable Filler Section.
Dermabrasion: For more information, please see our Dermabrasion Section.
Skin Lifting: This may be any sort of mini, or full-scale lifting technique. The procedure depends upon where you acne cars are located.

The Road to Recovery

The length, or severity, of your recovery depends upon which treatment option you choose. If you choose light, or nonablative options, your recovery will be shorter. If you choose ablative procedures such as laser resurfacing or dermabrasion, your recovery will be a little more extensive. Injectable fillers can create the least recovery impact, but may not fully eradicate your skin irregularities. Speak top your surgeon about the options and their recoveries before making your decision.

Risks and Complications of Acne Scar Removal

As with your recovery, this factor will vary with the treatment option chosen. Those which are more ablative, are riskier and include complications or effects such as hypo- or hyperpigmentation, additional scarring, skin thinning and possible infection. Injectable fillers can include granuloma formation, over-correction, and infection. Non-ablative procedures such as low level lasers and Radio-frequency can also cause hypo- or hyperpigmentation depending upon your skin type, facial fat loss and ensuing contour irregularities. Please discuss the risks thoroughly with your surgeon before committing to a procedure.

The Average Price of Acne Scar Removal

This will depend upon your chosen treatment option, and the amount of treatments needed. Full face ablative lasers can cost upwards of $3,000 and non-ablative averaging at $900. per treatment. Injectable fillers are often priced by the cc (cubic centimeter, volume), and not areas treated. This price will depend upon the filler used.