Acne Scarring & Treatment Options

June 2023

June is Acne Awareness month, so we’re talking with Board-Certified Dermatologist, Dr. Gregory Delost, who serves the Cleveland region, about acne scarring. Acne scarring is one of the most sensitive issues with skincare and often impacts mental health and self-esteem. Early, aggressive, and effective treatment is the best way to minimize and prevent acne scarring. We’re here to help with the understanding of scars and how to work towards healing them.

Before we jump into treatment options, let’s learn more about acne scars and how they are classified.

How are acne scars classified?

Acne scars are classified based on their appearance during an examination with your dermatologist. They can be depressed (atrophic scars) or raised (hypertrophic scars/keloids).

Atrophic scars are the most common. They are caused by the destruction of collagen, and present as indentations.

Atrophic scars can be classified into three categories: ice pick, rolling, and boxcar scars.

  • Ice pick scars are wider at the top of the skin and taper as they go deeper.
  • Rolling scars are shallower than ice pick scars. They have a wavy surface due to abnormal collagen attachment.
  • Boxcar scars are typically round or oval shaped dimples that can either be shallow (less than 0.5mm) or deep (more than 0.5mm).

Hypertrophic scars and keloids are less common. Both are thick, raised scars. Hypertrophic scars stay within the margin of the initial wound whereas keloids spread beyond the margin of the initial wound.

How are acne scars treated?

The ideal way to treat acne scars is a three-step approach, consisting of an initial treatment phase, a collagen remodeling procedure, and finally any additional treatments to address resistant scars and to supplement results of previous procedures.

Step 1: An initial treatment phase.

The initial treatment phase is focused on treating redness, and to treat individual scars that may be resistant to collagen remodeling procedures. Treating redness is important as the redness accentuates the scar and makes it more noticeable.

To target redness, VBEAM®, Forever Young BBL™ and Forever Clear BBL™ are great treatment options available. Typically, three to four treatments spaced out every month are necessary for optimal results.

To treat individual scars that may be resistant to other treatments, typically a surgical approach is preferred. Ice pick and narrow boxcar scars respond to the chemical reconstruction of skin scars technique (CROSS technique) where a high-strength (90-100%) trichloroacetic acid (TCA) peel solution is placed at the base of scars with the goal to promote dermal remodeling. Rolling acne scars are typically treated with subcision, a procedure in which a small needle is inserted under an acne scar with the goal of releasing the fibrosis tissue that teethers the scar and causes the depression.

Finally, another option to treat difficult ice pick and boxcar scars is to surgically remove them by punch biopsy.

Step 2: A collagen remodeling procedure.

This phase of treatment consists of procedures that induce collagen growth. Examples of treatments that can induce collagen growth include the HALO® Hybrid Fractional Laser, chemical peels, and microneedling with platelet-rich plasms (PRP).

Step 3: Additional treatments to address resistant scars and to supplement results of previous procedures.

After step 2 is complete, it is important to assess treatment response and determine if any other procedure would be beneficial. Possible treatment options during this phase include all of the previously mentioned treatments, along with injectable dermal fillers.

Dermal fillers are particularly helpful for broad, rolling scars. Ice pick scars and other tethered scars typically do not respond well to fillers.

At Optima Dermatology & Medical Aesthetics, our board-certified dermatologists and expert providers will work with you to identify the right treatments and help establish lifestyle changes that can promote clearer skin. We are accepting new patients – find your nearest location and schedule an appointment today to begin a healthier approach to skincare!