Acne scars may present in a variety of ways. The technical names are boxcar acne scars, ice pick acne scars, rolling acne scars, hypertrophic and keloid scars. Patients can present with a combination of these types of scars.
Treatment of acne scars also varies with the presentation of the scars. The more challenging acne scars to treat are boxcar scars and ice pick scars. Boxcar scars have more defined edges that appear like a box. Ice pick scars appear as small pits or enlarged pores on the skin. Hypertrophic and keloid scars are raised areas that are well defined or go beyond the boundary of the scar.
A series of chemical peels treating the entire face and then spot treating the actual boxcar scar or ice pick with higher TCA concentrations directly into the scar or angled borders can be very effective in some patients.
Fractional laser resurfacing is probably the most popular service offered for acne scars in our practice. The degree of correction is sometimes limited in darker skin types as lower energy levels must be used to prevent post inflammatory hyperpigmentation. A series of micro-needling sessions has proven to be an effective treatment for some patients.
Patients with depressed acne scars treated with dermal fillers are often highly satisfied with results especially if most of the scars are rolling scars without defined sharp borders. Dermal fillers can improve the scarring appearance significantly especially when there is underlying volume loss.
Since the days of bovine collagen, more dermal fillers have been developed. There are a variety of hyaluronic acid fillers. The following are the most common: Belotero, Restylane, Perlane, Juvederm and Voluma. These HA fillers vary in consistency and duration of action depending on the cross-linking of the molecular structure. The higher degree of cross-linking, the longer it takes the body to break it down. For more shallow scars Belotero, Restylane and Juvederm do well. Deeper scars can be treated with Voluma, the newest hyaluronic acid introduced in 2013. Although Voluma can last up to 2 years, results with these dermal fillers are still temporary.
The best news is that there may be hope for a more permanent solution to acne scars using ArteFill. Artefill is a lasting dermal filler approved by the U.S. Food and Drug Administration in 2006 for the correction of the nasolabial folds commonly known as "smile lines." A pivotal study is showing significant improvement in treating moderate to severe atrophic acne. Clinicians who have been injecting ArteFill since 2006 report impressive results that they had not been able to achieve in treating acne scars in the past.