Acne Scar Reduction in Washington, DC
Acne scars are a potential consequence of untreated cystic acne. Acne scars are textural changes on the skin surface which are visible to the naked eye and often create shadows in certain lighting. There are several distinct types of acne scars which are discussed below. Dr. Adrian is an expert in the treatment of all types of acne scars, and utilizes combinations of the latest surgical, chemical, laser, and RF based treatments available today with treatment plans tailored to each individual.
*To avoid confusion, ‘brown spots’ and ‘red spots’ related to acne are post-inflammatory hyperpigmentation and post-inflammatory erythema, respectively. These are a sign of active or recent acne and will resolve with appropriate acne treatment by a Board Certified Dermatologist.
Types of Acne Scars
Icepick scars appear as thin and deep ‘pitted scars’. These are most common on the cheeks however can appear on the forehead and temples as well.
Boxcar scars are broader but well demarcated scars with steep, sharply defined edges.
Rolling Scars are similarly broad depressions such as boxcar scars but have more gentle sloping edges. Rolling scars are due to scar tissue adhesions under the skin which pull down on the skin surface. These tend to be more noticeable when smiling or pinching the skin, unlike icepick or boxcar scars which are more superficial.
Atrophic scars are most commonly found on the back or chest but can also occur on the face. Atrophic scars are due to a loss of collagen in the area of the scar, leading to depression of the skin. Unlike other types of acne scarring, long-term color changes (lightening or reddening) of the area within the scar may be noted with atrophic scars, especially on the chest and back.
Hypertrophic scars are due to excessive scar tissue which develops during the healing process. Commonly referred to as keloids (incorrectly) hypertrophic scars present as , firm, raised, and sometimes contracted areas of skin. Like atrophic scars these are most common on the chest and back but can occasionally occur on the face. These are typically treated with steroid injections and laser treatment to reduce thickness and associated erythema (redness).
Treatments for Acne Scarring
TCA CROSS / PHENOL CROSS
CROSS (Chemical Reconstitution of Skin Scars) is a technique which uses the principles of chemical peeling applied to acne scars. This treatment, which is most effective for icepick scarring, involves the application of 50-100% Trichloroacetic acid (TCA) or Phenol (>84% Carbolic Acid), both of which are very powerful chemical peeling agents, directly to the base of ice-pick scars. This causes an intense and highly focused chemical peel at the base of the scar, stimulating the formation of new collagen leading to a reduction of scar depth over time. This is a quick and well tolerated treatment for icepick scarring with minimal to no downtime. CROSS treatments are performed every weeks and generally 5-6 sessions are recommended to reduce the depth of icepick scars prior to ablative or non-ablative laser treatments.
Acne Scar Subcision
Subcision is a tried and true method for the treatment of rolling scars and some boxcar scars. This technique relies upon the theory that many depressed acne scars, specifically rolling scars, are due to vertical collagen adhesions which develop between layers of collagen and collagen and the subcutaneous fat during the healing process of cystic acne. Subcision involves entering the skin adjacent to a rolling or large boxcar scar with a specialized needle (Nokor) or cannula and cutting/releasing these fibrous scar tissue bands, reducing adhesion of the skin surface to deeper tissue layers and smoothing the skin surface. Swelling and bruising for 10-14 days are common after treatment. While subcision is a highly effective standalone treatment for rolling scars when performed as a treatment series, a more effective approach we recently developed is to perform subcision with a blunt cannula followed immediately by injection of a biostimulatory filler such as sculptra. This combination therapy reduces the total number of treatments as well as the downtime associated with serial nokor needle subcisions.
Fraxel Non-Ablative Laser for Acne Scars
This laser treatment revolutionized the treatment of acne scars for individuals who could not tolerate the downtime associated with other treatments. This fractionated 1550nm laser targets water in the skin in a grid pattern, gently heating individual areas under the skin leading to a controlled wound which stimulates the development of new collagen in the 3-6 months following each treatment. This remains a popular treatment for patients desiring a low to no downtime option for laser treatment of acne scars. Treatments are performed monthly and 4 treatments per course are recommended to gauge results in between each course of treatment. Side effects include swelling and redness to the treated area for 2-3 days.
Radiofrequency Microneedling (Intracel) for Acne Scars
Radiofrequency Microneedling utilizes an energy based microneedling device to directly deliver RF energy (heat) underneath the skin surface to stimulate the formation of new collagen and improve the texture of all types of acne scars. Utilizing a similar concept to Fraxel Non-Ablative skin resurfacing, RF microneedling has the advantage of bypassing the outer layer of skin and delivering high energy directly to the collagen layer of the dermis. This protects the epidermis from heat induced inflammation which is beneficial when used on Asian skin and darker skin types which are prone to hyperpigmentation from laser based treatments. Generally 4 treatments spaced 1 month apart are recommended for each treatment course. Side effects from treatment include redness and mild to moderate swelling of the treated area which resolves in 2-3 days. Please note that RF Microneedling is not the same as ‘pen’ or ‘roller’ based microneedling which has shown to provide temporary improvement but no durable (long-term) improvement to textural acne scars.
Fractional CO2 Ablative Resurfacing for Acne Scars
Fractional CO2 resurfacing for acne scars utilizes a CO2 laser which both ablates (vaporizes) the skin surface while simultaneously delivering heat energy into the subsurface of the skin to stimulate new collagen development. Fractional resurfacing is best utilized as a ‘finishing touch’ after other scar specific treatments such as TCA cross, Subcision, Fraxel or RF Microneedling have been performed. This treatment can provide both smoothing of subtle acne scars along with significant improvement in overlying skin tone and superficial texture. Downtime of around 1 weeks is expected.
How Do I Remove My Acne Scars?
Acne scar treatment is a long process typically requiring a variety of treatment modalities for the best overall results. During an acne scar removal consultation, Dr. Adrian examines a patient’s individual scars and develops a comprehensive treatment plan to achieve maximal improvement with the least downtime and inconvenience possible. Please note, there is a $125 consultation fee for acne scar consultation with Dr. Adrian which is applicable towards future treatment if desired.